Author Topic: Credentialing  (Read 1555 times)

ttenaglia

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Credentialing
« on: January 16, 2012, 01:10:12 PM »
Hi,

When speaking with a potential client about billing services, the following questions came up...  I have been looking for answers, and then it dawned on me to use the forum here, as it was through the books that I got the potential client in the first place. :-)  So, any thoughts and/or guidance would be very appreciated.

1) Is it possible to credential a practice, or does each provider need to be credentialed individually?

2) Are there any things to keep in mind in terms of credentialing and fee schedules if the providers are contacted with the practice, as opposed to being employees or owners of the practice?

3) How can a provider renegotiate a fee schedule?

Thanks,

Tom

PMRNC

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Re: Credentialing
« Reply #1 on: January 16, 2012, 04:31:54 PM »


Quote
1) Is it possible to credential a practice, or does each provider need to be credentialed individually?

They will want the information for each provider, so in essence each provider needs to be credentialed in that practice.


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2) Are there any things to keep in mind in terms of credentialing and fee schedules if the providers are contacted with the practice, as opposed to being employees or owners of the practice?

Not sure what your asking, if you are wanting to know if they would have different fee schedules and such, no, they wouldn't. 


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3) How can a provider renegotiate a fee schedule?

This really isn't an answer I can answer in a forum, it really is not a good idea to get into contracts and negotiations unless you are fully experienced with the whole credentialing process and even then it requires getting down and gritty with contracts and it's a good idea to have an attorney to review each contract where negotiations come into play.  There's a lot involved when negotiating fee-schedules.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ttenaglia

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Re: Credentialing
« Reply #2 on: January 16, 2012, 05:19:15 PM »


Quote
1) Is it possible to credential a practice, or does each provider need to be credentialed individually?

They will want the information for each provider, so in essence each provider needs to be credentialed in that practice.


Quote
2) Are there any things to keep in mind in terms of credentialing and fee schedules if the providers are contacted with the practice, as opposed to being employees or owners of the practice?

Not sure what your asking, if you are wanting to know if they would have different fee schedules and such, no, they wouldn't. 


Quote
3) How can a provider renegotiate a fee schedule?

This really isn't an answer I can answer in a forum, it really is not a good idea to get into contracts and negotiations unless you are fully experienced with the whole credentialing process and even then it requires getting down and gritty with contracts and it's a good idea to have an attorney to review each contract where negotiations come into play.  There's a lot involved when negotiating fee-schedules.

Thanks for your answers.

For #1, that helps.  Thanks.

For #2, I'm moreso asking if there's anything different about the credentialing process when the providers are contracted, as opposed to employees.

For #3, I think what she was asking me is if it is possible to re-negotiate fees after a contract is already in place.  I guess you're saying have an attorney review the existing contract for the provider and each insurance company?

Thanks,

Tom

PMRNC

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Re: Credentialing
« Reply #3 on: January 16, 2012, 05:52:10 PM »
Quote
For #2, I'm moreso asking if there's anything different about the credentialing process when the providers are contracted, as opposed to employees.

Non providers wouldn't be credentialed at all. You'll need all their licenses, etc, some carriers will first require a letter of intent. It's also a good idea to have on hand any specialties that would warrant an "in" with a closed network.. for example, maybe your provider is the only one to provide biofeedback within that geographical area.


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For #3, I think what she was asking me is if it is possible to re-negotiate fees after a contract is already in place.  I guess you're saying have an attorney review the existing contract for the provider and each insurance company?

Yes first and foremost, always good idea to have the provider's attorney review contracts in place, yes you can sometimes get them to negotiate, but it's not as simple as calling them up.. again, lots involved here, all procedures have to be in place, you have to have an "angel/reasoning" for negotiating.. meaning maybe it's been 7 years and there's been no increase, or maybe the practice has seen a higher volume of another procedure. You also cannot negotiate based on what "other" providers are getting because many of these contracts contain non-disclosures so that would not go over well. There's also formula's for R&C, U&C to compare as well as approved amounts, geographical area, cost of living, etc.  Some carrier will have a process to go through, others will NOT negotiate at all. Negotiating the fees isn't even the biggest step, bigger step comes in evaluating new contracts to be sure carrier is not fixing you into a rate for a long term or making you stay within the network for longer terms than the provider should be tied to.  Very involved and again, should not be done without previous experience and/or knowledge of the process.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ttenaglia

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Re: Credentialing
« Reply #4 on: January 18, 2012, 12:13:26 AM »
Thank you for your help!  Very much appreciated!

Tom