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Collections and Credentialing

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williamportor:
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:
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:
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.

Michele:
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.

williamportor:
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.

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