Author Topic: Credentialing  (Read 3416 times)

Ty

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Credentialing
« on: May 25, 2010, 07:28:46 AM »
Are there any home based billers out there with Knowledge of getting providers credentialed?n If so, What are you charging for those services?

PMRNC

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Re: Credentialing
« Reply #1 on: May 25, 2010, 10:38:20 AM »
There are several tiers to credentialing, some will just do the initial credentialing and others like myself will go further into it such as reviewing fee-schedules, negotiating fee schedules and contract review, what I charge usually depends on the whether they want the full deal or just bare necessities. I charge my consulting rates on hourly basis and again that is going to depend on experience, location, etc. For just the bare necessities I might charge a flat fee per carrier.
Linda Walker
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Ty

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Re: Credentialing
« Reply #2 on: May 25, 2010, 11:32:39 AM »
So for inital credentialing is it just as simple as completing the application with the insurance company and monitoring it through the end of its process? The reason I'm asking is because I have a prospect that wants me to help with credentialing and although I know where to go to get them started, I haven't done it before and I want to make sure I'm not committing to something that I cant handle because Its way over my head.

Pay_My_Claims

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Re: Credentialing
« Reply #3 on: May 25, 2010, 03:53:12 PM »
Medicare is one of the toughest, have you looked at the credentialing book that Michele & Alice wrote?

DMK

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Re: Credentialing
« Reply #4 on: May 25, 2010, 04:04:37 PM »
Please, please, please study up before doing Medicare!  I thought I dotted every i and crossed every t and it still took freaking forever because of a dumb error!!!!!  Do whatever Michelle and Charlene tell you to!  They're the best!!

Ty

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Re: Credentialing
« Reply #5 on: May 25, 2010, 06:10:25 PM »
I havent read Michele and Alice book on credentialing. Where can I find it??

PMRNC

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Re: Credentialing
« Reply #6 on: May 25, 2010, 07:47:24 PM »
I think Medicare is the easiest!!  Some of the mental health TPA's are a pain in the rear end.. Medicare is at least a uniform process but I've never had a problem.

I too also want to agree with the others, please make sure you study up and don't JUMP into credentialing!!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Pay_My_Claims

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Re: Credentialing
« Reply #7 on: May 25, 2010, 08:46:09 PM »
its on their website. and again, you really need to look into what is involved with credentialing. that one client you are trying to get by doing something you are not trained in, can create a mess for you in the end. if not done properly you would have invested time to end up with nothing.


Michele

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Re: Credentialing
« Reply #8 on: May 25, 2010, 08:48:57 PM »
Information on our Medicare Credentialing book can be found at http://www.medicalbillinglive.com/medicare-enrollment.shtml

I agree with Linda, I like Medicare.  Some find it to be a pain, but I find it straightforward.  Like Linda also said, there are many levels of credentialing.  Personally I don't get involved in fee schedule negotiations.  You shouldn't jump in over your head, but initial credentialing, starting the process, obtaining and completing that apps shouldn't be too much for you.  But if there is something you are unsure of ASK - don't just fill it out!  We too did credentialing when we first started to help us secure accounts.

Best of luck

Michele
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sherry27

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Re: Credentialing
« Reply #9 on: May 25, 2010, 09:39:48 PM »
I think Medicare is the easiest also. I wish they were all like Medicare. But KY Medicaid is a major pain. Indiana Medicaid insurances are the most messed up mess I have ever seen.  I started my 1st 2 doctors from  the ground up..( But like others have said, you do need to understand billing and how it works, you need good billing experience or you will probably end up messing stuff up .I had done billing for 4 years) You just start calling and document everything and before long they will be all set up with the insurances. I was friends with them though from the office that i had worked at before. It has been quite rewarding seeing nothing turn into something for drs that I care about. They are now a thriving business.  Me personally, I am done with credentialling, it is too time consuming. But I am glad I did it. I am not saying I won't do it again, but only if it's a for a friend or someone special.

Pay_My_Claims

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Re: Credentialing
« Reply #10 on: May 25, 2010, 11:03:47 PM »
toughest-as in the most long drawn out time consuming mess!!! BCBS of NC was probably worse, to me as far as the requirements.

Ty

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Re: Credentialing
« Reply #11 on: May 26, 2010, 07:28:35 AM »
Thank you all for your advise. I think I will just stick to what I know. However I will look into getting Michelle's book on credentialing and taking some courses in it because I would like to be able to offer that as a service adventually.