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Medicare Credentialing Services

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PMRNC:

--- Quote ---we should go through the valuable information to improve our Business.
--- End quote ---

The value of enrolling in Medicare? I make it a practice not to lie to my clients. (little joke there) in all seriousness, I've not more opt out's of both Medicare and Medicaid. For Medicaid I usually just go ahead and take the ones out that want to get out but if they are a Medicare provider looking to opt out, I do a complete practice analysis FIRST. There is way too much that goes into credentialing and DE credentialing to just pull a provider our or get them setup with one. There are many variables that go into it, steps that should be taken to determine the health of the practice BEFORE enrollment or opting out.  I very rarely do credentialing w/out other services, I perform practice financial analysis, audit's, policies/procedures, compliance training/staffing,  I can't really remember if I've ever done JUST the credentialing. I have more consulting clients that return to me for one reason or another or on a bi-annual basis than I do billing and it nets more profit for sure. I also don't just do the tier one credentialing, I do contract and fee schedule review and negotiations as well, I either use the provider's attorney to assist me or my own and we split the job. But again there's no straight forward IN or out of most carriers and it's vital to any practice to see how that enrollment or opt out is going to effect their bottom line.  The exception is Medicaid.. if the provider wants out that's great I'll take him out because 90% of the time the practice will MAKE money getting rid of Medicaid, the other 10% needed to first get their marketing of their practice in order because they were too heavily dependent on Medicaid. OR their area dictated they be, in which case they probably should look for another job.  :o

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