Medical Billing Forum

General Category => General Questions => Topic started by: TxJFP on February 09, 2011, 10:09:06 PM

Title: Credentialing
Post by: TxJFP on February 09, 2011, 10:09:06 PM
Hello All,

Well I've been doing medical billing for the past 3 years and actually working with a medical billing firm for the past year. My current boss DOES NOT teach anything as far as how to successfully do things and correctly. My main question is how to do credentialing? I have a great idea on getting started with that, since I "listen-in" to what my boss asks over the phone. Anyway, could someone possibly leave a checklist on what all needs to be taken place or done? I'd really appreciate it  ;)

An extra note, I do plan on opening my own billing business BUT I would also want to feel more confident in stating I do know how to do credentialing if ever asked from a provider.

Thanks y'all,

Jesse
 
Title: Re: Credentialing
Post by: PMRNC on February 10, 2011, 06:32:53 AM
Quote
Well I've been doing medical billing for the past 3 years and actually working with a medical billing firm for the past year. My current boss DOES NOT teach anything as far as how to successfully do things and correctly. My main question is how to do credentialing? I have a great idea on getting started with that, since I "listen-in" to what my boss asks over the phone. Anyway, could someone possibly leave a checklist on what all needs to be taken place or done? I'd really appreciate it  Wink

An extra note, I do plan on opening my own billing business BUT I would also want to feel more confident in stating I do know how to do credentialing if ever asked from a provider.

Thanks y'all,

Well, you really can't fault your boss for not teaching you their job so you can go do it on your own <g> you might want to check and see if they have a non-compete clause you might have signed when you started.

Credentialing is actually pretty straight forward. There are a few tiers of it. I have a legal background and a lot of experience so I actually take the credentialing all the way to the fee-schedule negotiations and contracts. I make sure my clients have an attorney to sign off on everything but they (clients) love the full service credentialing. If you are just going to do the basic credentialing you would need to gather the provider's credentials first. Contact the carriers to see which ones are taking new providers and ask them what the first step is. Some of them will actually send you the required applications and things and others will ask you instead to submit a "letter of intent" (LOI). I will do an LOI even to the panel's that say they are closed because they will make exceptions if your provider performs a service or has a unique service, close to an area they don't have panel providers. From there you complete the packets they send you, review any fee-schedules they send (some send them, some won't until you are in)
If you receive contracts, strongly recommend your client have an attorney to look them over. Most don't do this and don't realize that with Obamacare coming down the road, they might be roped into harder "opt out" rules, longer wait times to "opt out"  I have seen carriers like BCBS tie a provider in for 18 months in one state and in another 90 days.     Some people have software to do credentialing CAHQ I believe, but I never found it too helpful, maybe a little quicker but not much more help than I needed.
Title: Re: Credentialing
Post by: TxJFP on February 10, 2011, 07:32:37 AM
Thank you for this helpful information :D