Medical Credentialing for Doctors and Physicians

We Know a Medical Credentialing Team That Offers Medical Credentialing for Doctors and Physicians

Doctors typically work very long hours and are on call for emergencies. Days are spent running tests and interpreting them, prescribing medicine and treatments, doing rounds in the hospital, making notes about a patient’s physical conditions, advising patients about how to maintain their health and discussing further treatment with them. On top of that, doctors keep current on the medical profession by taking classes, as well as reading books and medical journals. With weeks that can stretch to 100 hours, there’s not enough time in the day to fit in medical credentialing.

Do-it-yourself medical credentialing is a tedious process, and it’s best to do it if you have a lot of time and patience. For each application, phone calls must be made to check on progress, ensure you’re on the right track to meet the deadlines and supply additional documents if necessary. Medical credentialing is a “necessary evil,” something that must be done for a thriving practice. But, where will you find all the extra time to dedicate to medical credentialing?

While you focus on your patients and the many responsibilities of your practice, the professionals we recommend will expertly complete the process of medical credentialing.

Medical Credentialing for Doctors is Necessary

1) It’s a “Must” to Accept Insurance

Whether you’ve just started in the medical field or you’ve been a doctor for years, medical credentialing is indispensable for your practice. Years ago, it wasn’t uncommon for healthcare providers to only accept cash for their services. Healthcare has changed since then, and those practices have to get medical credentialing in order to keep their doors open.

Being on insurance panels—or “in network”—with the insurance plans is important. Healthcare in the U.S. is more available. When doctors are on insurance panels, they are able to accept third-party payments from new patients and those they hope to attract to their practice—it is imperative if you want to grow the practice.

2) Patients Require Covered Services

While accepting cash for services was common in the past, more and more individuals with insurance are visiting their doctors. When people are paying higher costs for healthcare, and HMO plans are becoming the norm in lieu of PPO plans (meaning that out-of-network benefits are fading fast), patients require that doctors accept their health insurance plans. Another factor is that healthcare is becoming more equal, where services are covered for a new condition or one that has existed.

With the high costs of healthcare premiums, patients want to ascertain their healthcare is being paid for by the insurance company. Doctors need to keep up with their current patients and new ones if they want to have a flourishing business. They need to be enrolled in the insurance plans and get medical credentialing.

Do-it-Yourself Medical Credentialing for Doctors is an Extremely Tedious Process

If you endeavor to complete your own medical credentialing, there are a few things you should know. First, you need to have plenty of time available and a lot of patience. There are guidelines for each insurance panel that must be strictly adhered to or the consequences can be not meeting a deadline and starting the entire process from the very beginning. The following are some of the things to keep in mind if you take it upon yourself to do medical credentialing.

  • First, make a decision about the insurance panels you would like to be on.
  • For each insurance application, you must research the latest one to use. This means being on the phone, staying on hold until you reach the appropriate department and finally reaching the correct person to find out.
  • Applications can span from 30 to almost 100 pages—and that is for each one. It is imperative to pay attention to detail, because the applications must be filled out in certain formats.
  • More time on the phone is necessary to track down your application and ensure it was received. There are times when applications are delivered to the wrong department or are found in the wrong pile. If this happens, they can be stagnant for days or weeks–and if enough time has passed, they may be rejected or miss the deadline. This scenario means you will have to start the application process from the very beginning.
  • If an insurance company needs more information, you must find the documentation and send it to them.
  • There’s more time to spend on the phone if you want to make sure each application is on track to being approved. Failure to follow up could mean a glitch in the process, and it starts again. It’s a good practice to call each insurance company every other week.
  • The worst case is if an application is rejected. If that happens, a formal appeal must be made as a response.

The Ideal Choice for Medical Credentialing

Wouldn’t it be better to save yourself from the headaches of do-it-yourself medical credentialing? Consider working with our friends at East Meadow Management Group. They can offer a timely quote or help you find a solution to your problem. You can reach them at  516-277-8291 or by filling out this quick and easy form here.

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