Physician Credentialing: Worth Getting Right to Get Paid

As physicians, despite your reputation for benchmarked medical services, you could be losing out when it comes to realizing medical bills reimbursed fully from respective health insurance carriers. And when you start to analyze that elusive reason responsible for hampering your reimbursements, you would invariably end up discovering ‘Credentialing’ as the chief culprit. Quite contrast to the earlier scenario, wherein your credential as a qualified and competent practitioner could alone determine your practice’s sustenance and growth, the present day scenario, characterized by innumerous practitioners and heterogeneous mix of insurance carriers, requires your practices to bear the stamp of ‘Credentialing’ to stay well clear of audit, delay or denial exposures.

Although, physician practices require to be credentialed from Federal Health Agencies (for being compliant with requisite health care standards) as well as Medicare and Medicaid, and respective private insurance carriers (for being compliant with medical billing standards), it is the latter that assumes greater significance as it has direct impact on operational optimization and revenue maximization. Credentialing in the medical billing context means that your medical practices are compliant with the benchmarked clinical and operational practices as deemed suitable by the prevailing health insurance convention. And as we stand at an important juncture when health insurance sector is realigning its revenue structure post the Federal Government’s radical healthcare reforms, there is a growing emphasis being laid on Credentialing, first by the Centre for Medical Services, and then by private insurance carriers – making it mandatory for physicians to have their practices duly Credentialed.

But, owing to its exhaustive process, Credentialing itself could be one of your major pre-occupation, relegating the all important medical practice to the second! Here are the series of process that would invariably have to clear for being eligible to Credentialing:

•  Preparation of paper CMS 855 & other Managed Care applications for all payers
•  Preparation and submission of online applications to federal and non-government carriers
•  New provider affiliations and Group Contracts
•  Maintaining and updating specific Provider information directly with carriers at frequent intervals or when requested
•  Resolving enrollment issues and tracking Managed Care contracts
•  Validating information provided by payers
•  Handling Provider letter of interest & enrollment transactions
•  Setting of Provider information in the Practice System
•  Obtaining Contracted Fee Schedules and negotiating changes
•  Preparation of contracting documents for scanning and long-term storage electronically
•  Preparing, maintaining and monitoring Managed Care Summaries that Provides Effective dates, Fee Schedule details and Group affiliation.
•  Monitoring Expiry dates for NYS-Registrations, DEAs, and CLIA registrations and also handling re-applications for the same.
•   Handling Re-Credentialing whenever required
• But, because of its inevitability and the incidental benefits that come with a well-documented Credentialing, it is prudent that you outsource from competent and proven medical billing companies that can offer quality services at a more economical cost than it would cost if it done internally. The following overriding advantages should amply justify the efficacy of going for outsourced Credentialing:
•  Insurance carriers pay better to the physicians who are in par with the insurance
•  Credentialed physicians are considered as reliable providers and are listed in the ‘preferred physicians group’ from which patients usually select their physicians in order to get maximum benefits and avoid ‘out of the pocket expenses’.
•  Since physician credentialing involves complete background check on providers’ educational qualifications, professional licenses, experience, fellowship programs, and residence, it helps in controlling the healthcare fraud-related crimes and ensures that only qualified physicians deliver services to patients and thereby improving the quality of healthcare in US
•  Credentialing offers comprehensive access to the fee schedule, which aids in knowing in advance the exact quantum of medical billing for diverse medical practices rendered.
•  Credentialing is also an accelerator of strategic clinical networks and market expansion as your practices begin to command unprecedented goodwill in the medical fraternity.

We, www.medicalbillersandcoders.com – known for offering imperial Credentialing, both as an individual component as well as an integral part of our comprehensive suite for Medical Billing Revenue Cycle Management – should be your preferential choice for “Outsourced Credentialing”.

Ohio tops in EHR usage, with the other states catching up

According to Ohio Health Information Partnership, around 6,750 doctors in Ohio, the maximum count of physicians compared to any other state, have committed to electronic health records (EHR), leading the nation in usage of EHR’s. Greater Cincinnati has nearly 985 physicians who have committed to or are already using the records systems. Ohio is currently transitioning its legacy Medicaid Management Information System (MMIS) into a new Medicaid Information Technology Architecture (MITA) compliant system.

Various other states are following suit, more than 60% Medicaid providers in Florida are interested in applying for incentive payments for the meaningful use of electronic health records as reported by the journal Health Affairs, while more than 1,000 providers in South Carolina are now on the road to meaningful use. California Healthcare Foundation has reported that 55% percent of California’s primary care physicians use an electronic health record in their practice.

The federal coordinator for health information technology announced that almost 100,000 primary care providers across all the states have committed to electronic records. An upward trend has been observed across US states in consumer use of EHR’s, with total EHR market revenues expected to increase by $6.5 billion in 2012 as compared to $973.2 million in 2009, according to a report by  Frost & Sullivan.

• In contrast to the growing trend, implementing the meaningful use attestation standards by the current healthcare organizations has been at a slower rate
• Amongst the total of 114644 users registered in an EHR system, only 8303 actually meet meaningful use standards and qualify for federal incentives

In this scenario, physicians can look for medical healthcare experts/services to achieve the required benefits of an electronically governed paperless office. Amongst the top reasons for other Physicians not accepting EHR uncertainty, time involvement and implementation efforts seem to be topping the list. They are fervently looking for professionally unbiased opinion on choosing the right EMR and successfully implementing it.

Medicalbillersandcoders.com has been helping physicians not only in Ohio but across the 50 states choose appropriate technology for their individual practices and also offers professional support and assistance to healthcare providers to keep abreast of the changing industry norms, and successfully qualify for federal incentives through meaningful use of electronic health records.

For more information visit:Medical billing companies, Ohio Medical Billing

Driving Physicians’ Practices towards Accelerated EMR Implementation

“Notwithstanding the incentive bait for ‘Meaningful Use’, and penalty threat for ‘Non-compliance’, there has an encouraging statistics about migration from manual to digital form of healthcare practice management. But, considering the quantum of target to be reached to meet Macro EMR/EHR objectives, we are miles away from the originally conceived vision of idealizing healthcare management processes.”

There has been an unprecedented impetus on EMR/EHR system since the recent Healthcare Reforms promulgated by the Federal Government. While the decision to emphasis on EMR/EHR stems out of the overriding necessity of providing a controllable and qualitative medical care to the growing population base, the healthcare fraternity itself is going to be the beneficiary at large.  Eventually efficient EMR/EHR system implementation will bring about a transformational change in capturing, processing, and collaborating clinical data for enriching quality medical care as well as efficient practice management that augment practitioners’ operational efficiency and revenue maximization.

Notwithstanding the incentive bait for ‘Meaningful Use’, and penalty threat for ‘Non-compliance’, there has an encouraging statistics about migration from manual to digital form of healthcare practice management. But, considering the quantum of target to be reached to meet Macro EMR/EHR objectives, we are miles away from the originally conceived vision of idealizing healthcare management processes.

In view of this prevailing scenario, physicians’ practices that are apprehensive of joining the EMR/EHR bandwagon should be taken into confidence, and be familiarized with the efficacy of migrating to the digital form. The following list of potentially transformational advantages will make a world of good to dispel clouds of apprehension amongst physicians:

• EMR/EHR as a means of improving Patient Care:
  The ultimate goal of an EMR is to improve patient care by offering physicians and clinical staff a consolidated view of relevant patient information and enabling immediate EHR access to the data. By digitizing and making patient information available online, there are fewer paper records in circulation and, therefore, less risk of lost records and incomplete data at the point of care.
• Leveraging Record Storage Facility:
  EMR/EHR platforms provide unimaginable the quantum of data storage for future clinical reference and collaboration; physicians would do well to benefit from such technology installations.
• Increased Physician Productivity:
  Physicians can sign deficient records online – increasing productivity while reducing record delinquencies and administrative costs associated with retrieving and processing incomplete medical records.
•  Enhanced Turn-Around Times
  Electronic, secure and centralized patient records result in a more efficient process for responding to audit requests – improving turn-around times, reducing costs and minimizing the risk of audit-related penalties.
• Increased Patient Throughput:
  Many functions of medical record processing, such as assembly, filing and manual retrieval, can be eliminated – improving overall processing time and patient throughput.
• Improved Revenue Cycle:
  A consolidated electronic medical record minimizes the time necessary to collect patient information after discharge and enables bills to be dropped faster – improving accounts receivable (AR) days and discharged-not-final-billed (DNFB) accounts.
• Centralized Coding:
  Digitizing patient records upon discharge enables healthcare providers to leverage offsite coders – centralizing coding functions for multi-facility organizations and further reducing the revenue cycle.

As practitioners embark on these transformational practices, they are bound to encounter the decision on choosing apt EMR/EHR installations from amongst innumerable available in the market. And, with their limited to core-medical practices, such decisions are not going to be easy and can sometimes be repenting. But, with competent service providers at their disposal, practitioners can easily off-load such risky decisions to the providers who possess the requisite credentials.

Medicalbillersandcoders.com, being credible source for comprehensive revenue cycle management, stands uniquely poised to address EMR/EHR issues that have a direct bearing on:

• The Meaningful Use mandate, which is part of the American Reinvestment and Recovery Act of 2009 (ARRA)
• The requirement to adopt ICD-10-CM [International Classification of Diseases, Clinical Modification/Procedure Coding System (ICD-10)]
•  HIPAA 5010 standards (Health Insurance Portability and Accountability Act of 1996)

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