General Category > General Questions

Credentialing

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BillingMaster:
Hi everyone,

I have a client that is asking for credentialing, what is the going rate per hour for this service.  Also, I have been asked to do an audit on some old billing
from their previous billing company.  Should I charge a percentage or flat fee?  Help!!!  ;)
Phyllis

PMRNC:
"Credentialing" is a bit vague. Can you be more specific as to what they want? there are various levels of credentialing.
As for audit's I charge my hourly consulting rate, I wouldn't recommend a percentage of collections on an audit.. ever. it's not ethical. Your hourly rate will depend on your experience as well. I've charged anywhere from $150 to $300 per hour depending on what they want, type of specialty, etc. I perform all my audit's "IN HOUSE" ..again this is for ethical reasons, most practices who want an audit are usually trying to find something or they are preparing for something. This provides peace of mind for them and covers my butt.

Denise35:
Hello Billing Master,

I have made credentialing a component of my practice management package and I charge $1200 -1800 for small practices and $1500 to $2400 for large practices which is paid in monthly installments.  Because of the "potential" credentialing, contracting issues, and recredentialing opportunities derive within the course of the year in any given practice and I handle them all for the providers I serve.   This a separate contract from coding and billing component.   

However, if you simply wants to charge a one time fee, PMRNC method is a reasonable one. 

I hope this helps,

Denise35

dc006:
Hi Denise35:

May I ask where you received your credentialing training or how did you learn all of the steps for credentialing and recredentialing?  It has been hard to locate on-line or off-line training for credentialing.

Also, how did you come up with those practice management package rates?

BillingMaster:
Thanks PMRNC for the good information regarding the credentialing. Now for the next issue.  My client does pain management, does alot of procedures, epis, facets, joint inj. ect. Most patients need an authorization from ins. I have been asked to take on this task.  He says he needs approx. 250 auth's per month, not sure how much per auth to charge.  I'm figuring maybe 15 minutes of time for each auth.  Can you advise me on this.

Thanks
Phyllis :D

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