Expert Medical Credentialing for Nurses

Expert Medical Credentialing for Nurses

As a nurse, your attention is focused on your patients and helping to run a quality practice. Between getting health histories to performing physical exams to providing health education, each day brings different scenarios and challenges.

With days devoted to patients and your numerous responsibilities, it’s a good bet you have very little time left for the burdensome process of medical credentialing. It takes an inordinate amount of time to do the credentialing yourself, including filling out applications and spending time on the phone making sure they arrived and are being processed. That doesn’t even take into account waiting on hold. Without follow up, the process can be compounded when the application is buried in a pile on a desk—or is lost—by the insurance company. In that case, the deadline may have expired, and the process must begin all over.

We know experts who can relieve you of the task of medical credentialing, so you can keep up with the demands of a busy practice and the care you provide to each patient. They have provided affordable medical credentialing for thousands of health practitioners. This team has experience working with medical credentialing and can save you from the morass of paperwork, beating the deadlines, and finding time for phone calls. Here are a couple reasons Medical Credentialing is so important:

1. Accepting Insurance is Indispensable

Medical credentialing is becoming a necessity to nurses, whether they are just starting out in a practice or have been in the field for decades. While so many healthcare providers have experienced success with cash-only practices, it is now indispensable for them to get medical credentialing. It is crucial to get on insurance panels–or be “in network”–with insurance plans, because healthcare in the country is more broadly available. (Being on insurance panels allows practitioners the eligibility to accept third-party payments from new and potential patients—a must for maintaining and growing the practice.)

2. Patients Call for Covered Services

Practitioners who used to accept cash-only payments are now seeing more people with insurance plans because of healthcare reform. With the skyrocketing cost of healthcare and HMO plans more prominent than PPO plans, out-of-network benefits are becoming a thing of the past. Added to that is the fact that, whether a condition is new or pre-existing, it is possible for the services to be covered.

Patients today are not meek about asking if their insurance is accepted. They request it. The days of patients paying out-of-pocket for services by healthcare providers are fading fast. Patients who pay the ever-increasing costs of healthcare premiums are making sure their healthcare is paid by insurance companies. With this in mind, healthcare providers want to make sure they attract new patients—and maintain their long-time patients–by accepting insurance. The bottom line is that being enrolled in insurance plans and getting credentialed is necessary for the practice to thrive.

Do-it-Yourself Credentialing is Overwhelming

Make sure you have a lot of time and patience if you opt to do your own credentialing. The process is time-consuming, and there are many requirements for each insurance panel.

  • First, figure out which insurance panels you want be on.
  • Set aside the time to call insurance companies to find the most up-to-date applications available.
  • Fill out the applications, which can range from 30 to nearly 100 pages each (this will take you about 10 hours per company).
  • Be aware that each application calls for information in certain formats.
  • Once the applications are sent to the insurance companies, call each one to affirm they have been received. Sometimes applications make their way to the wrong desk and sit for days or are lost. In this case, deadlines for the applications may lapse, and everything must start from the very beginning.
  • Many times, insurance companies will need more information, so it is necessary to supply it to them expediently.
  • Call each insurance company every two weeks to ensure the applications are there and are being processed.
  • In the case an application is rejected, a formal appeal must be submitted in response.

We Know a Credentialing Team That Can Help

If the process of do-it-yourself credentialing sounds like a huge amount of time, stress and work, you probably aren’t looking forward to it. However, credentialing is critical today. Forget the burden of do-it-yourself credentialing and hire someone to do it for you: consider our friends at East Meadow Management Group. They’re available to offer a timely quote, or help you find a solution. You can reach them at  516-277-8291 or by filling out this quick and easy form here.