Things To Consider Before Starting Credentialing Process

Things To Consider Before Starting Credentialing Process

Credentialing is a popular term among providers, especially among physicians who, just ten years ago, could simply perform cash only services. In contrast, nowadays patients are demanding that providers accept their insurances for payment. Hence, those who don't want to lose clients and scare potential patients away should go through the credentialing process.
Getting credentials mean filling out and retrieving multiple applications with insurance companies, then submitting everything to them, and then constantly following up. Even though it may sound simple, many would agree the process is nightmarish as it usually doesn't go smoothly, and many providers have to submit their applications multiple times, spending time contacting insurance companies and fighting delays and rejections. Moreover, many panels can simply say that they don't accept people with your specialty or they are full.
While the credentialing process will never become one of your favorite things to do, there is still something you can do to make the credentialing a bit easier.
Create a list
Research all insurance companies and choose those you want to get credentials from. Each company has its own credentialing process, so be prepared to submit different application forms and go through multiple interviews.
Complete the CAHQ
The Council for Affordable Quality Healthcare, or CAHQ, is usually required to complete the credentialing process. Almost all big insurance companies, like Aetna or BCBS, use CAQH applications. Thus, you should get yourself acquainted with the system.
First of all, you can't simply upload your information on CAQH, you need to be invited there by an insurance company. And if you remember that "chicken or the egg" thing, you can imagine how it feels when you need to submit an application to an insurance company. Once you submit it, you should call them to check if they actually received anything and generated a CAHQ number for you. And then you can go to CAHQ and complete the application that you have already sent to the insurance company, which is waiting for the complete application to arrive.
Never submit CAHQ applications on paper
Even though you can choose to either submit an online application or send it on paper, never choose to send papers. First of all, their application is over 50 pages long. And second of all, when you send your application on paper, CAQH hires a data entry person to transfer your data. And if you think it takes a lot of time...they just never do it. Many physicians have submitted their applications on paper and CAHQ simply lost them. And if you call to CAHQ, they will also ask you to submit the application online.
Devote around 10 hours for each insurance company you want to get credentials from
Don't expect that getting credentials will only take ten minutes of filling out the application. Usually, you need to spend 10 hours of labor for every insurance company. It includes getting and filling out forms and applications, organizing documentations, and checking the process of credentialing.
Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.
©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved.

 

How To Make Sure Of The Doctor Experience And Qualifications

How To Make Sure Of The Doctor Experience And Qualifications

Credentialing process usually mean that a hospital aims to optimize the utility of their crucial recourses - providers - and ensure highest quality patient care possible. The concept is quite old and slowly getting easier, thus more and more hospitals try to perform a thorough credentialing process and creating new quality standards.
Professionals determine credentialing as the process of collecting, verifying and evaluating qualifications and skills of healthcare providers who want to provide patient care services in a certain healthcare facility. Each hospital has its own set of standards and requirements that their providers have to meet. Credentials mean evidence of training, education, licensure, skills, experience and other qualifications.
There is also a process called privileging that accompanies credentialing. Privileging means a process by which healthcare organizations allow practitioners to perform a certain set of services related to their specialty, based on thorough evaluation of their credentials. Credentialing and privileging ensure medical quality; they help assess initial qualification and prove competence.
Verifying quality care
The importance of credentialing can't be underestimated and hospitals have to credential their providers to ensure quality care. It's vital to maintain the high standards of medical care, thus regular verification of qualification and re-credentialing ensure patient safety, provision of quality health services and reduction of possible medical errors.
Hospitals are expected to provide quality care through accurate diagnoses and proper treatment of their patients who come to get the services. Medical providers are the ones who deliver these services and their level of competence and knowledge determines if the patient receives appropriate care.
The credentialing process also ensures that hospitals act according to current laws, state and federal requirements and standards of other certifying organizations that relate to operation of hospitals with regard to the recruitment of its practitioners. Credentialing helps prevent the hiring of a candidate with fraudulent training and degrees to the hospital. After getting credentials, privileging process ensures that practitioners are allowed to perform a certain set of procedures under supervision at the hospital.
Basics of the credentialing process
Professionals believe it's better if every hospital develops its own standards and documents of this process, thus it's impossible to find a guide with all steps that will describe norms and procedures of the process. However, there are many similarities in processes of different hospitals; they mainly differ by specific characteristics of each facility, such as recourses, patients served, etc.
The only way to determine the qualifications of medical providers is to get information about their education, training, and licensure, and to review their data in details. The methods that hospitals use to accomplish this difficult task should become routine as the medical staff becomes familiar with them.  The hospital has to be sure that its patients are treated properly and that it hires only qualified practitioner, who would perform certain services to the patients.
Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.
©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved.

Important Steps to Physicians Credentialing

As a physician, you already know how important the credentialing process and privileging is. These are two aspects that ensure patient safety and high-quality service, but do you know how to apply for it?

Step one - collecting necessary documents

All physicians work hard to become who they are and credentialing (a complicated process of confirming the qualifications of the practitioner) is the most important part of your ability to perform quality services to your patients. Credentialing simply means the verification process that confirms that you, as a physician, have all qualifications, credentials and background for membership in a healthcare organization (such as a hospital).

The credentialing process includes the confirmation of all professional degrees, licensures, clinical training, training certificates, residence certificates, continuing education credits and many more. All these documents are needed to confirm whether or not you meet the latest standards of practice and regulations set by each institution.

The most common documents that you will need:
• Proof of identification
• Proof of DEA licensure
• Proof of education and training
• Work experience
• Military service
• Board Certifications
• Letters of Reference
• Health Status
• Hospital affiliations
• Criminal check
• Malpractice insurance
• Claims history
• Sanctions disclosures

Unfortunately, there is no centralized credentialing process, so it can get quite complicated and time- and money consuming. You have to create different submissions for every entity, have to keep off the records and make sure that everything is error-free.

Step two -applying for privileges

When you're done with credentialing, it's a perfect time to apply for privileges. It's a process that grants you with an authorization to provide specific services or treatments at a certain healthcare facility. Privileging can be divided into three main categories:
• Admitting privilege that allows you to admit patients to the hospital
• Courtesy privilege that allows you occasionally to admit and treat patients at the hospital
• Surgical privilege that allows you to operate room surgeries

This is an important step in physician credentialing since it ensures the healthcare facility that you have the experience, skills and competencies necessary for the services you're going to provide. Once the privilege is approved, you can conduct certain services in a certain facility. For example, a doctor in private practice may want to apply for privileges to perform surgeries, and can even get privileges from more than one facility. Moreover, hospitals are also obliged to answer regulatory entities like Accreditation of Healthcare Organization or The Joint Commission on Accreditation to ensure all physicians are properly privileged at the facility.

Record-keeping is an important part of successful credentialing process

Just as credentialing, the privileging process is long and complex. You will have to provide a lot of details, prove your education, competency, fellowships, residence, licensure, insurance and many more - and get ready to different interviews with the committee and a board of directors: that is an essential part of any investigation process. Both credentialing and privileging are documented, formal procedures that require adherence to every rule and regulation for granting clinical privileges and admission. This means they are the key parts of delivering patients the highest standard of care.

Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.

©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved

What Does The Affordable Care Act Mean For Americans?

The Affordable Care Act, or Obamacare, will reduce prices for health coverage making it accessible for millions of Americans. Almost 60 million Americans live without insurance, and the law addresses issues concerning inequalities in affordability of health care services, increase access to affordable, quality health coverage, invest in wellness, and give people control over their health care.
According to researchers, there are higher rates of disability, mortality and chronic disease in rural areas. For that reason, the Affordable Health Care Act will transform the insurance industry to improve the health of rural Americans.

Health Insurance Marketplace and rural coverage
At the beginning of 2014, almost 8 million rural Americans under age 65 got new opportunities to get affordable health care through the Affordable Care Act. Just think of the numbers:
• Almost 20% of uninsured Americans live in rural areas
• The vast majority of rural Americans lack proper health care compared to urban Americans
• Rural Americans usually have lower income level, thus subsidized insurance coverage through Marketplaces is necessary
• the Health Insurance Marketplaces should increase competition in rural areas - especially in those states where one insurance company dominates more than a half of the insurance market
• Residents of those states that are expanding Medicaid will get affordable coverage
The Marketplace will lower costs due to increased competition. It will influence rural areas the most, since at least one out of every five residents there faces medical debts and families have to cover almost 50% of the health care payments out-of-pocket.

The Affordable Care Act for Rural Americans
Uninsured Americans from rural areas can use the Marketplace to compare different insurances based on benefits, quality, price, and other factors knowing all premiums and cost-sharing amounts, which should help them pick the perfect health insurance plan that will fit their needs. Each insurance plan should at least cover all essential health benefits, such as emergency and inpatient services, prescription of drugs, behavioral health treatment, and pediatric care.
New coverage options with insurance benefits are already there for rural Americans:
• More than 30 million Americans now can expand preventive services without cost sharing. Among these services, there are blood pressure screenings, well-child visits, mammograms and pap tests for women and flu shots for adults and children
• Over 11 million disabled rural Americas who get coverage from Medicare now also can access different preventive services without cost sharing, such as colorectal cancer and diabetes screening, prevention plans, bone mass measurements, and many others
• More than 600,000 rural Americans below 26 now are covered under individually purchased plans or their parent's employer-sponsored plan
• Private insurance policies can't have lifetime limits anymore, and annual limits should be more than $2,000,000.
• Americans under age 19 cannot be denied coverage due to a pre-existing condition
Insurances won't have to be cheap, but they certainly will be less expensive and you don't have to pay unexpected costs out of the pocket as if you did without insurance. There are also tax breaks for families with low incomes, which help pay for their insurance.

Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.

©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2016.  All Rights Reserved.