Starting a Medical Billing Business > Starting Your Own Medical Billing Business
credentialing
pjbriese:
I am just starting a medical Billing company and I have Drs asking about credentialing, where is the best web site to find info on this subject and is there a cost for this?
Pay_My_Claims:
Credentialing
From Wikipedia, the free encyclopedia
Credentialing is the process of establishing the qualifications of licensed professionals, organizational members or organizations, and assessing their background and legitimacy. Many health care institutions and provider networks conduct their own credentialing, generally through a credentialing specialist or electronic service, with review by a medical staff or credentialing committee. It may include granting and reviewing specific clinical privileges, and medical or allied health staff membership.
The process is generally an objective evaluation of a subject's current licensure, training or experience, competence, and ability to provide particular services or perform particular procedures.
pjbriese:
Thank you very much, I know what it is, I was just wondering what resourses to use and if there is a charge for this, I know I can add it as an extra service. Just wondering if they charge to do this. Once again, thanks for the info, very much appreciated.
Steve Verno CMBS, CEMCS:
There is credentialing and provider enrollment.
Credentialing is when a hospital does a thorough backgound check on the doctor to allow the provider to have privileges to see patients within the hospital.
Some insurance companies require the provider to do the same before they allow the provider to treat their member and to pay the claims for those visits.
Some insurance companuies do this as a means of backdooring a provider to a contract. This allows the insurance company to pay the doctor a reduced fee for services rendered. Some insurance companies will not pay for claims while the credentialing/enrollment process is taking place.
Medicare and Medicaid require enrollment by the provider. This is done through the processing of a submitted enrollment packet and could include background checks and fingerprinting.
Credentialing and enrollment should not be done as an extra service offered by billers inexperienced in contracting, insurance credentialing or enrollment requirements. There are some professional companies that offer this as their sole service but it is not cheap. Billers should stick to billing only.
Pay_My_Claims:
--- Quote from: pjbriese on August 30, 2009, 01:43:57 AM ---Thank you very much, I know what it is, I was just wondering what resourses to use and if there is a charge for this, I know I can add it as an extra service. Just wondering if they charge to do this. Once again, thanks for the info, very much appreciated.
--- End quote ---
Sorry, but your question was where can I find out about it.........lead me to believe you didn't know what credentialing was. I agree with Steve, if you don't comprehend what it is,simply tell your physicians, that you don't currently offer those services. There is a lot that can be done with Billing Services (Practice Management Companies) that are not done by all. There are some that don't do DME/HME or dental billing. Its perfectly acceptable to state you don't offer those services.
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