Author Topic: Collections and Credentialing  (Read 2515 times)

williamportor

  • Full Member
  • ***
  • Posts: 170
Collections and Credentialing
« on: November 12, 2015, 11:21:22 AM »
In addition to billing services, the two things I'm asked about most by prospective doctor clients is helping them with collections and credentialing. I always outsource these two tasks, since I don't know how to do  credentialing, and collections in my state requires a separate license and additional training. As my business continues to grow however, I'm wondering if I should add these two things to the billing services that I offer.  I'm not ready to dive into these areas right now, since I only have 6 billing clients, but would this be a good idea for the future?

kristin

  • Sr. Member
  • ****
  • Posts: 494
Re: Collections and Credentialing
« Reply #1 on: November 12, 2015, 06:24:10 PM »
Yes, I think it would. All the billing companies I work for do collections as part of their contract, and the more experienced ones also do credentialing.

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Collections and Credentialing
« Reply #2 on: November 13, 2015, 02:18:07 PM »
Why would you need license for credentialing?

As for collections.. some states require licensing and surety bonds depending on the actual actions taken for collections. A TRUE collection service IMHO does everything from skip tracing, credit reporting and actually collecting the money. So you can offer certain collection services depending on your state. Some states require even a surety bond even if your not collecting money but still acting as a collection agency/biz.

I'm stumped though as for why it would require license for credentialing. I do think there are two tiers to credentialing and basic credentialing anyone can do, it's the work involved that comes with doing it all the way. For example I know a lot of billing companies that offer "credentialing" and wouldn't know how to analyze fee schedules, geographical data, fee schedule negotiations and contract reviews.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4770
    • Solutions Medical Billing
Re: Collections and Credentialing
« Reply #3 on: November 14, 2015, 01:21:12 PM »
He said he needed a license for collections, not credentialing.  :)

Personally I agree with Linda about the collections.  I have always steered clear of that.  We work with a collection agency (a very good one that is nation wide) and we make it seemless so the provider doesn't feel the extra work. 

As for credentialing, I do think that is a good service to offer.  Too many insurances require re-credentialing or re-validation on a regular basis and I want to make sure my docs don't have any disruptions.  If I handle it then I know it's being taken care of.  We have a large practice that has a separate credentialing company (their old billing service) that they have a contract with.  Lets just say that things aren't handled the way that I think they should be and we see a lot of disruption in payments because of it. 

I don't do contract negotiation, just basic credentialing.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

williamportor

  • Full Member
  • ***
  • Posts: 170
Re: Collections and Credentialing
« Reply #4 on: November 15, 2015, 12:59:30 PM »
Thank You for the info. everyone. Yes, I did mean to say my state requires a license for collections only, sorry for the misunderstanding.

If I may ask, how does one learn to do credentialing?  I tried to do this with a part time client once, and the result was many hours spent on the phone, with Noridian (Medicare) and little to show for my efforts.

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Collections and Credentialing
« Reply #5 on: November 15, 2015, 03:25:27 PM »
Quote
If I may ask, how does one learn to do credentialing?  I tried to do this with a part time client once, and the result was many hours spent on the phone, with Noridian (Medicare) and little to show for my efforts.

I've always found Medicare to be the easiest. The other carriers were the headaches. Did you run into a specific problem with Medicare?

I know some billing companies will do basic credentialing but I have found that the way to capture a more diverse market is by offering more advanced credentialing services such as fee schedule and contract negotiations, re-credentialing, analysis, etc.  Of course Medicare is straight-forward but I'm talking all other carriers.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

williamportor

  • Full Member
  • ***
  • Posts: 170
Re: Collections and Credentialing
« Reply #6 on: November 23, 2015, 06:42:59 PM »
Well, it seems that learning to do credentialing is a matter of simply diving in and learning by doing. If that's the case, it opens up some very interesting possibilities for growth! I wonder...does this apply both basic and advanced credentialing? 

Cpatel

  • Jr. Member
  • **
  • Posts: 51
Re: Collections and Credentialing
« Reply #7 on: November 24, 2015, 09:38:41 AM »
Credentialing is very helpful tool to grow business as well as to maintain existing clients. I offer Credentialing/Revalidation for all my clients and is priced per payer.  I work with Medicare of multiple regions and Noridian is the most easiest one. Their staff is very helpful. BTW, you can get your own PECOS login. Medicare Credentialing and Revalidation is very simple and fastest way through PECOS. Like, Michelle I do basic Credentialing but not contract negotiation.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4770
    • Solutions Medical Billing
Re: Collections and Credentialing
« Reply #8 on: November 25, 2015, 08:39:17 AM »
Cpatel,  how did you get your PECOS login?  I was told you had to get permission for each provider in order to use PECOS which seemed like a pain.  I still do paper apps!
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Collections and Credentialing
« Reply #9 on: November 25, 2015, 09:44:38 AM »
You can get your own login: https://pecos.cms.hhs.gov/pecos/login.do#headingLv1

Quote
You may register for a user account if you are: an Individual Practitioner, Authorized or Delegated Official for a Provider or Supplier Organization, or an individual who works on behalf of Providers or Suppliers.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4770
    • Solutions Medical Billing
Re: Collections and Credentialing
« Reply #10 on: November 28, 2015, 08:14:43 PM »
Thanks.  I haven't looked into it in quite a while.  I'm so familiar with the paper apps I've just always preferred them.  I know the providers cannot share their log in and last time I looked into it (when it first came out) it seemed like a pain.  I will have to take another look!
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com