Author Topic: Pricing on Credentialing  (Read 3715 times)

macbook

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Pricing on Credentialing
« on: October 12, 2011, 04:31:23 AM »
Hello Alice,

In your book, Completing the 855i, it was mentioned that a $125 fee is charged. We are deciding how to price our credentialing. I also got your book on Pricing but did not touch on how to price credentialing. Hope you can share some insights on how to price this as well.

Thank you,

PMRNC

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Re: Pricing on Credentialing
« Reply #1 on: October 12, 2011, 06:43:58 AM »
To me that's way to high for just Mediacare since it's standard, quick and easy. With all the others it depends on what level of credentialing you are doing. there is Level one which is just LOI, applications and status check and then level 2 which goes into fee schedule negotiations and contract review (should not be done w/out an attorney to sign off on contracts).  The fee can greatly be increased with doing full leveled credentialing. I've charged between $100-$200 per hour.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Re: Pricing on Credentialing
« Reply #2 on: October 13, 2011, 06:55:40 AM »
The $125 is just for credentialing with Medicare, no fee negotiation.  However, it includes tracking the application thru the finish, submitting any requests for corrections or additional information.  It also includes the 460 & 588 EFT and 855R is needed.  I would agree the $125 is high if it were just for completing the 855I but it is more involved.  I find that the work I do after we've submitted the I is where my time is taken up.  Chasing the provider down to get corrections, new signatures, etc.  Also, we did a comparison of others across the country and we actually are under priced by a lot, believe it or not! 
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macbook

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Re: Pricing on Credentialing
« Reply #3 on: October 13, 2011, 06:12:27 PM »
Hello Michelle and Linda,

Thank you so much for your reply. We are having an increase in credentialing for new providers and providers new to the practice. I am just having a hard time with pricing whether to charge for each insurance or as a package and how much.

But the list can really go up to 30 insurances/payers/networks all together or more.  And sometimes the corrections, and the issues I have to deal with, with established providers wishing to start their own practice having all their information in a chaotic state and fixing their information and getting it right in all the applications and getting their docs in order, especially getting them privileges in hospitals and of course Medicare. I sometimes feel if it is worth the price. Your book helped a lot. I am using a different email here in the forum. But the Medicare book really helped a lot especially when I was starting. How I wish Alice could help in the pricing as well as negotiating contracts. Negotiating contracts will really help our clients get better returns.

But, anyway, thank you again for all your input. 

billinggirl

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Re: Pricing on Credentialing
« Reply #4 on: November 15, 2011, 07:17:31 PM »
How would you track your hours if you charge the 100 to 200 per hour rate?

PMRNC

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Re: Pricing on Credentialing
« Reply #5 on: November 16, 2011, 11:44:26 AM »
I use ACT which is a contact management program and all my clients are loaded in there and there I can keep track of EVERY SINGLE thing BY client. There is a built in timer/management feature.. if I'm working on a client and the hourly rate applies (consulting, credentialing) I hit the time button, and when finished I hit stop and it prints a report automatically which I can email, save to the contact in ACT, fax, etc all from the program itself. I setup tasks that correspond with the project so that the final report not only includes the time but the tasks I've accomplished.  Never had a client question it because it's pretty detailed and would probably take me LONGER to fudge it or make it up.. LOL   Think of all the MANY MANY jobs done and paid by the hour.. time honored tradition that still works.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

asilva03

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Re: Pricing on Credentialing
« Reply #6 on: April 20, 2012, 12:51:26 AM »
Hi Linda,

I am currently using the ACT software and was wondering where is the Time/Management feature that you mention?

Thanks,

Aleshia

PMRNC

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Re: Pricing on Credentialing
« Reply #7 on: April 20, 2012, 06:03:11 PM »
Once you have the contact open, it's under tools, click on timer, once you hit the stop you can input details for that event/task.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

asilva03

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Re: Pricing on Credentialing
« Reply #8 on: April 24, 2012, 12:06:06 AM »
Thanks Linda.

PMRNC

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Re: Pricing on Credentialing
« Reply #9 on: April 24, 2012, 08:01:44 AM »
The problem I run into with pricing per carrier with credentialing is that time varies and factors so differently.. I've had ones that looked to be straight forward at first glance and then wham you hit a road block or paperwork isn't in order and you can easily go beyond that fee with your time. If I'm doing level 2 credentialing especially, there's back and forth with the practice attorney with the contract, the carrier, letters back and forth, faxes, research (fees), etc so it's so much more involved I could never do a flat fee which is why I do hourly. the provider gets a full time report with each project so they can see how the time was spent.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com