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    Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.


    4 Steps to Painless Physician Credentialing

    Posted by Carl Mays on Thu, Sep 05, 2019 @ 10:00 AM

    4 Steps to a Painless Physician CredentialingThe famous Chinese philosopher Confucius once said, "A man who does not plan long ahead will find trouble at his door." This is true, especially with healthcare providers in the U.S. and their physician credentialing process.

    In a study conducted and published by the Beckers Hospital Review, it has been revealed that a one month delay in physician credentialing can result in a $30,000 loss in revenue. This amount further increases for higher billing specialties such as cardiothoracic surgery and orthopedics. Thus, it is important for healthcare providers to plan properly for their physician credentialing procedure to ensure their cash flow will run smoothly in 2019.

    These steps will help you organize your physician credentialing process:

    Step 1: Start Early

    Physicians Practice, an online publication, said that most physician credentialing can be done within 50 to 90 days, but it is best to give your practice a 120-day leeway. This is because the internal timeline of the payer who processes the application varies, differing from one payer to another.

    Given this timeframe, it is best to start your physician credentialing process earlier, preferably prior to hiring.

    Step 2: Pay Attention to Detail

    Perform the necessary due diligence when submitting your application.

    Many physician credentialing delays are caused by incomplete and incorrect information. This is a simple mistake that can cost you a huge sum of money. Thus, it is important for your team handling the physician credentialing process to pay close attention to all of the required information.

    Double check to see if all of the entries have been properly filled out. In doing so, you'll have a more efficient physician credentialing process, which means completing it within 50 to 90 days. Plus, you avoid going through the process of re-applying.

    Step 3: Remain Updated with the Coalition for Affordable Quality Healthcare (CAQH)

    In December 2018, CAQH announced new functionality for Verifide ™, This automated solution verifies the accuracy and completeness of credentialing information submitted by healthcare providers to health plans.

    This will now become the primary source verification (PSV) as it offers real-time visibility into your credentialing application status. As a result, your practice will have an easier time knowing the reason behind your physician credentialing rejection or denial.

    Thus, you should always be in the loop with the latest updates provided by CAQH.

    Step 4: Be Knowledgeable with State Regulations

    State regulations vary from one another. For some states, a physician credentialed by Provider A in another state may be streamlined in their states; others may allow a physician to avoid the full credentialing process again when moving from one practice to another within the same state.

    Just take a look at Texas. A credential verification organization has been launched through the collaboration of Texas Medical Association and 19 Medicaid health insurance plans. The organization’s goal is to reduce paperwork for Texas physicians.

    Amanda Hudgens, director of special projects for The Texas Credentialing Alliance (TAHP), stated:

    "We want to simplify the credentialing process for physicians here in Texas and we're focusing on Medicaid providers because we understand they have a lot of paperwork burdens and administrative requirements to become a Medicaid provider."

    Thus, it is important for the one handling your physician credentialing to know all about these varying state regulations.


    The physician credentialing process remains a tedious process if you do not have all the information you need up front. Following the above recommendations will help speed up this process while eliminating inefficiencies.

    Subscribe to our blog for more tips related to medical billing or call us toll-free at (855) 376-7631 for your queries and concerns.

    About ClaimCare

    ClaimCare helps new medical practices and existing organizations with their physician credentialing process. They even assist in training your front desk office staff for a more efficient medical billing process. Learn more.

    Tags: medical billing resources, credentialing, medical credentialing

    4 Common Pitfalls and Issues of Medical Credentialing

    Posted by Carl Mays on Mon, Aug 19, 2019 @ 02:00 PM

    4 Common Pitfalls and Issues of Medical CredentialingBeckers Hospital Review has revealed that just a month in delay on an average primary care physician's medical credentialing can cost your practice $30,000. This could even be higher for specialists who handle orthopedics and cardiothoracic surgery.

    Avoid this loss from happening to your organization. Learn the common issues associated with medical credentialing and how to solve them.

    1. Lack of Organization and Bad Workflow

    An efficient workflow will help you avoid medical credentialing problems and delays. Create a workflow to avoid lost money in handling appeals and reimbursements.

    Hire an office coordinator who will be:

    • In charge of your physician’s documentation process
    • Send reminder texts and emails for documents that are not yet submitted
    • Neatly compile these credentialing documents for easy retrieval

    This will help lessen human error in your workflow. Thus, avoiding the need for a re-credentialing process, which will only lead to a longer medical credentialing process.

    2. Lack of Timing and Physician Start Dates

    It’s good to be optimistic, but with medical credentialing it is best not to put things at a minimum, especially with estimating the time needed for the approval of your physician credentialing request.

    Gather all the needed credentialing paperwork on the day the employment offer is given. As needed, extend the start date of your new physician to a maximum to ensure you have properly reviewed and verified all of his or her credentials before joining your organization.

    3. Private Background Checks and Maintaining Updated Contact Information

    Medical credentialing is never easy. Payers will certainly use anything that can deny the payment claim. Therefore, it is important for your organization to diligently perform a private background check on your physician.

    Verify the validity of all the forwarded documents including:

    • License
    • Training
    • Employment history

    Most importantly, ensure the submitted contact information is up to date. The medical credentialing process may take a while, approximately 6 weeks to 3 months. Thus, it is important to know how you can contact them if any additional documents are needed by the payer.

    4. Adhering to All the Needed State Requirements

    Be reminded that states vary with their needed medical credentialing requirements. Additional credentialing requirements may still be necessary even if the physician has successfully been credentialed in another state. Therefore, it is better to check on reciprocity agreements with the payer organization and the state before agreeing to immediately accept the physician into your organization.

    Improve your organization's cash flow while providing quality healthcare to your patients. Do not let obscure state laws cause your office to lose productivity. Understand the laws of your state to make your medical credentialing process faster and easier.

    Do you have more questions about medical credentialing? Subscribe to our medical billing blog or complete our online form for any of your queries and concerns.

    About ClaimCare

    ClaimCare is one of the largest medical billing and medical credentialing providers in the United States. Its entire medical credentialing staff are thoroughly screened, well trained, and provided with the best tools and proper incentives to ensure you are given the best services. For more information about the services we deliver, phone (855) 376-7631.

    Tags: credentialing, medical credentialing

    3 Major Benefits of Outsourcing Your Medical Credentialing Process

    Posted by Carl Mays on Tue, Jun 18, 2019 @ 11:30 AM

    3 Major Benefits of Outsourcing Your Medical Credentialing ProcessIn dealing with the complexity of the medical credentialing process, some healthcare providers still rely on spreadsheets, checklists, and makeshift programs without an expert to verify these entries. This results in several enrollment errors and delays.

    Some practices have no dedicated team to handle the credentialing process. Thus, their staff is left juggling their intended responsibilities with other tasks, which only results in inefficiencies and delayed enrollments.

    Outsourcing your medical credentialing helps eliminate these problems while offering the following benefits:

    • Reduced operating and administrative costs
    • Reduced errors in the enrollment and credentialing process
    • More time to focus on building your practice

    Recent ClaimCare blogs provide in-depth information on why Proper Medical Credentialing is a Vital Necessity and How to Avoid Delays and Mishaps in the credentialing process of verifying your medical staff information regarding:

    • Education and certifications
    • Training and work experience
    • Other professional qualifications

    This is vital because unless a physician is enrolled your practice cannot file medical claims for the services he or she delivers. This means no revenue generated for your practice or facility.

    Medical Credentialing and the Rising Administrative Costs in the HealthCare Industry

    The administrative expense in the US accounts to 8% of healthcare costs. This includes activities related to planning, regulating, and managing health systems and services such as medical credentialing.

    Kevin Schulman, a professor of Medicine at Duke and co-author of the "Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care," shares the reason behind this in the following statement:

    "The extraordinary costs we see are not because of administrative slack or because healthcare leaders don’t try to economize. The high administrative costs are functions of the system’s complexity."

    One source of this complexity is the multiplicity of payers in the American health system. This includes private insurances and several public health programs such as Medicaid and Medicare.

    With the variety of processes required by these payers resulting in increased administrative costs, the healthcare industry needs to consider all the possible cost-reduction solutions for operational efficiency. This includes choosing a third-party provider to handle your medical credentialing process.

    Medical Credentialing Outsourcing for Reduced Administrative Costs and Better Patient Care

    Below are three ways on how medical credentialing outsourcing can benefit your practice:

    1. Reduced Operational and Administrative Costs through Medical Credentialing Outsourcing

    In an article published in the Harvard Journal of Medicine, David Cutler Ph.D, Elizabeth Wikler B.A., and Peter Basch, M.D. shared that streamlining your electronic transactions, standardizing your reporting requirements and provider enrollment, and the credentialing system is one of the best solutions to your cost concerns.

    How much savings are we talking about? It is estimated to be $29,000 per physician in a year.

    2. Reduced Errors Resulting in a Faster Medical Credentialing Process

    With a third-party provider, you are working with expert medical staffers who are skilled and knowledgeable regarding all the recent updates on the medical credentialing process. This ensures your enrollment submission has minimal to zero errors.

    As a result, you have a faster enrollment process that allows your practice to earn more revenue.

    3. More Time to Focus on Building Your Practice

    On average, a U.S. physician spends an average of 43 minutes each day on health plan administrative functions. This is equivalent to 261 hours of saved time in a year (365 days).

    Now you can say goodbye to these administrative functions because an outsourced medical credentialing provider will do it for you. Your time can be used to focus on building your practice while delivering better services to your patients.

    About ClaimCare

    ClaimCare is one of the largest medical billing and medical credentialing providers in the United States. Its medical credentialing staff is thoroughly screened, well trained, and provided with the best tools and proper incentives to ensure you are given the best services. For more information about the services we deliver, phone us at (855) 376-7631 or subscribe to our Medical Billing Blog.

    Tags: medical billing operations, credentialing, medical credentialing

    Avoid Medical Credentialing and Provider Enrollment Delays and Mishaps

    Posted by Carl Mays on Tue, May 21, 2019 @ 10:00 AM

    Competence_in_dictionaryNo enrollment means no payment.

    When a new physician joins your practice, it is of utmost importance for your practice to expedite his or her medical credentialing and enrollment process. Credentialing specialists at ClaimCare can help you do this effectively (doing the right thing) and cost efficiently (doing the thing right).

    Having a fast and reliable medical credentialing process is important.

    As you are probably aware, only after a health plan has awarded your new hire with an "effective date of participation" can this physician’s claims be properly submitted for payment.

    How much are you losing?

    A disrupted cash flow for your practice occurs when an “uncredentialed” physician cannot receive payments for claims while waiting for the practitioner to be enrolled with patients’ health plans.

    According to various reports, approximately $30,000 in lost revenue happens to an average primary care physician with just a month of credentialing delays. This amount increases substantially for higher billing specialties such as cardiothoracic surgery and orthopedics.

    3 reasons to outsource your medical credentialing and enrollment process:

    1. It helps reduce costs while safeguarding stored data.

    Allowing a third party medical credentialing provider to handle the enrollment and credentialing process lowers your expenses. It allows you to utilize top-rated hosting and security technology without the need to pay for the installation, implementation, and maintenance of servers and data encryption software.

    2. It brings better efficiency through robust Key Performance Indicators.

    Third party medical credentialing providers give your practice efficient tracking, trending and reporting data. This includes the following:

    • In-process charges
    • Department processing times
    • Provider process times
    • Days in Enrollment (DIE)
    • Quality measurements for updating payer follow-up notes

    This data allows you to easily establish performance baselines that can help improve your practice. This results in an expedited enrollment and medical credentialing process.

    3. It reduces medical credentialing and provider enrollment errors.

    Third party providers put the credentialing process into a single team that handles the centralized verification office. They are composed of trained, highly skilled, and knowledgeable individuals who are experts in completing your credentialing and enrollment process. This reduces the errors for your practice.

    The bulk credentialing approach of third-party providers also makes it easier for your organization to gain a "delegated status". Once acknowledged, you'll have an even faster enrollment and reimbursement process for your practice.

    So why continue to wait for 60 to 120 days before your credentialing process is completed if it can be done faster and more efficiently? Subscribe to our blog or call us at (855) 376-7631 to learn more about the medical credentialing process.

    About ClaimCare

    Healthcare Tech Outlook named ClaimCare as one of the nation’s “Top 10 Medical Billing Companies” in 2018. This honor follows previous such honors, including being ranked in the “Top 5” by the online magazine, Money & Business. We have a proven track record of increasing client collections by 10 to 20 percent. Talk to us to learn more about our medical credentialing services.

    Tags: medical billing, medical billing services, medical billing resources, credentialing, medical credentialing

    Proper Medical Credentialing is a Vital Necessity

    Posted by Carl Mays on Mon, Apr 22, 2019 @ 08:01 AM

    Importance of Medical CredentialingMedical credentialing for all practitioners in your group is one of the first steps you should think of when starting your own medical practice. This is essential in dictating the financial stability of your organization.

    What is Medical Credentialing?

    Medical credentialing has been defined as: "the process by which insurance networks, healthcare organizations, and hospitals obtain and evaluate documentation regarding a medical provider's education, training, work history, licensure, regulatory compliance record, and malpractice history before allowing that provider to participate in a network or treat patients at a hospital or medical facility."

    Based on this definition, it is easy to see why skipping the process is a definite ‘no’ for any medical practice. Not obtaining proper credentialing can lead to lost revenues. This means not being able to collect your medical office bills for various services provided by the uncredentialed professional on your team.

    Various reports show that a month’s delay in credentialing for an average primary care physician can result in more than $30,000 in lost revenue. Thus, it is an absolute necessity for any medical practice to ensure the medical credentialing process is working efficiently.

    4 Tips for a More Efficient Medical Credentialing Process

    For a more efficient medical credentialing process, ensure the following are put into place:

    1. Get Adequate References (Preferably Five)

    Hospitals and other health systems often require three professional references before approving a medical practitioner.

    Dare Hartsell, RN, MSN, the vice president of clinical services for a large healthcare group, says their organization “requires three references from applying physicians. All three references must be physicians of the same specialty who are not related by blood or marriage, and none of the references may be members of the physician's practice.”

    However, the credentialing specialist who verifies the validity of these references will not waste time following-up a reference on file who is unresponsive. So, if you have listed only three references but one of them is hard to reach, it is most likely for your application to have a longer processing time.

    By giving five references, you are giving the credentialing specialist more references to consider. This results in a speedier processing time.

    2. Ensure Your Documents are Up to Date

    Guarantee that these documents are up to date:

    • Council for Affordable Quality HealthCare (CAQH)
    • Drug Enforcement Authority (DEA)
    • CLIA Certification
    • Any other ancillary services that require proof of accreditation
    • IRS Letter Confirmation of Established Tax ID Number
    • Articles of Corporation (LLC, PA, INC., etc.)
    • License
    • Malpractice Insurance

    If any of these documents have to be renewed annually, then ensure the document submitted to you by your physician is still valid.

    3. Start Early on Your Medical Credentialing Process

    It is normal for the medical credentialing process to last from 50 to 90 days from receipt of the initial application, but could take up to 120 days depending on the quality of the application and other circumstances. Thus, it is best to get your forms submitted early, especially during the start of the year.

    The earlier you do this, the sooner your physician can work for your practice.

    4. Know Your State’s Credentialing Requirements

    It is vital to know the medical credentialing requirements set by the state, especially for anyone starting a practice in a new location. This includes additional fees that may be required by:

    • Medicare
    • Medicaid
    • Tricare or V.A.
    • Durable Medical Equipment Regional Carrier (DMERC)

    Stay on top of things. Know the recent requirements set by your state to ensure a faster medical credentialing process.

    Final Thoughts on the Credentialing Process

    Sometimes, it is best to let a third-party provider handle the medical credentialing process for you. For one, these companies have established a long-standing relationship with payers. Thus, they already know the common mistakes and errors that slow down the credentialing process.

    For more tips on how to make a smoother credentialing process, subscribe to our blog.

    About ClaimCare

    ClaimCare delivers credentialing and contracting services to medical practices, including start-up practices in almost all states in the US. We guarantee 85% of your charges to be resolved within 60 days and 95% of your charges to be resolved within 120 days. Learn more about our Service Level Guarantee.

    Tags: credentialing, medical credentialing

    Medical Billing Update: July 6 PECOS catastrophe fast approaching

    Posted by Carl Mays on Fri, Jun 11, 2010 @ 06:44 PM

    medical billing pecosUntil recently physicians believed that they had until January 3, 2011 to comply with Medicare's PECOS enrollment requirement. This is no longer the case. In May Medicare announced that a new mandate from the health system reform law forced the deadline to be moved up by 6 months. Starting July 6, 2010 if the physicians that refer to your practice are not properly enrolled in the Provider Enrollment Chain and Ownership System (PECOS) then your cashflow will be interrupted. If a claim is submitted to Medicare after July 6th with a referring physician that is not enrolled in PECOS, then Medicare can reject the claim. This means that your practice needs to work with your referring provider base and ensure that your referring providers are enrolled in PECOS. This is a much higher burden than the more typical medical billing situation where a provider only needs to ensure the he or she is enrolled with a payer.

    In order to mitigate any risk to your practice's cashflow you need to:

    • Generate a report of your top referring providers,
    • Call and check the PECOS system to confirm that your practice's key referrers are properly enrolled (you will need basic information about the providers such as name, tax ID or provider ID),
    • Contact any referring providers that are not properly enrolled with PECOS and make certain they know: 1) they are not enrolled with PECOS, 2) why it is critical that they enroll with PECOS, and 3) how to quickly enroll with PECOS (to eliminate any delays on their part in finalizing their enrollment), and
    • Send thank you notes to all of the providers that are enrolled with PECOS (this is a great way of showing them how much you value their referrals).

    With all of the healthcare bills and Medicare cuts taking up mind share and discussion time, it would be easy to miss the critical PECOS medical billing deadline and find that the 21% Medicare fee cut is one of two big reimbursement problems. Take action TODAY to ensure your practice's cashflow.


    Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.

    Tags: general medical billing questions, 2010 medical billing changes, credentialing

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