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How to Jump Start Your Physician Credentialing

June 7, 2016 | 2:01 pm
Published by | Krunal Popat

While physician credentialing is a labored procedure, it is a vital one as well. Each physician who becomes a part of a practice will require being credentialed. This long, laborious process results in the authentication of the knowledge, motivation, and proficiency of the physician to provide the best in medical care.

Unfortunately, if the process of physician credentialing is delayed or not done in a deliberate fashion, it can cause unforeseen issues that may result in delayed or even denied payments. When not properly credentialed, a physician will have a tough time getting their practice up and running which means that revenues are not being generated.

However, it can be addressed in a manner that can speed up the process and make it less labored. While this form of credentialing still takes time, it can be far less involved if you follow a few tips.

Start as Soon as Possible
The earlier you can start the process, the sooner it will end. While you will need to give it enough time for it to be completed, roughly 90 up to 150 days, it will pay if you start the process as soon as possible. This is because the process of physician credentialing is dependent on the payer as they have their own path to follow.

Pay Attention to the Details

Quite often the credentialing process is delayed because the details were not followed correctly. This means you will need to get a proper checklist and the right documentation so that you do not miss the small details. This is especially true for malpractice insurance, any perks, coverage info, start date, attestations, and work history.

Follow State Regulations
While most states have similar regulations, there are usually some important differences so you will need to pay attention to what is required. This means contacting the proper authorities and the medical society or group management association so that you can follow the correct procedures right from the beginning.

Council for Affordable Quality Healthcare (CAQH) Updates
Basically, regularly updating and getting yourself attested within the CAQH, you can make the process of credentialing & re-credentialing even faster.

Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
You can initiate Medicare enrollment action using Internet-based PECOS. It is much faster than paper-based enrollment. It also gives you more control over your enrollment information, including reassignments.

Expedite Application Process
You should work with others in the market to make the application process go as fast as possible. There are several ways to do this starting with requesting your Managed Care Organization (MCO) to ask the Management Services Organization (MSO) to do a single, one-time credentialing in order to avoid any unnecessary delays in the processing.

The -Q6 Modifier
Some payers allow for the -Q6 modifier which allows the billing of the physician to go through on a locum tenens. This means that patients will be assigned on a temporary basis to another physician as long as they are returned to you when the physician credentialing process is finished.

Create List of Healthcare Facilities that Need to Be Informed
Basically, take a spreadsheet and put on it all healthcare facilities, payers, and third parties that are required to be informed about the process you are undergoing. By following up with this process, you can stay on top of the situation. You may need to purchase credentialing software or find an outside source that can do this for you.