Medical credentialing ensures patients receive the best quality care from credentialed providers; in other words, it’s basically an industry standard that helps maintain quality assurance. Credentialing also means that providers can file claims with various agencies, such as private insurance companies and Medicare. However, the medical credentialing process can take months and is tedious—that’s why it’s so beneficial to outsource this process. Keep reading to learn more!
What Is the Medical Credentialing Process?
Medical credentialing is vital for all new hires, but it’s also performed at regular intervals even after hiring to conform to the standards of regulatory organizations including The Joint Commission (TJC), The Centers for Medicare and Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA).
The medical credentialing process typically involves three phases and can take up 180 days:
Credentialing
During this phase, a provider’s qualifications and experience are verified and evaluated. For example, the credentialing authority—known as a Credentials Verification Organization, or CVO—will contact the university or school where the provider received their degree; this authority will also contact certification boards and licensing agencies to confirm the provider’s standing and relevant credentials. Other employers will attest to work experience as needed; essentially, this phase involves verifying the background and experience of the provider going through the credentialing process.
Privileging
This intermediate phase of the credentialing process gives the provider permission to perform specific services at the proposed institution based on your credentials being verified. Basically, the provider has been recognized for demonstrating competency in their field. Privileging is an important step because it validates your credentials and enables you to perform the services you have experience in.
Enrollment
The final component of the medical credentialing process is enrollment. This allows you, the provider, to bill and be reimbursed for the services for which you have been credentialed and are privileged to perform. Naturally, this is the end goal for holistic providers who are billing insurance companies or programs like Medicare because this phase solidifies your standing in the healthcare and holistic marketplace.
Who Can Become Credentialed?
The medical credentialing process is for any healthcare provider who needs to be credentialed in order to maintain competitiveness and be vetted for insurance or Medicare billing. A multitude of different kinds of facilities and services are obliged to acquire and maintain the proper credentials to act as healthcare providers, including:
- Durable Medical Equipment
- Home Health Services
- Hospice Care
- In-Home Care Services
- Prosthetics/Orthotics
- Radiology/Diagnostic Imaging
Essentially, the medical credentialing process can apply to any individual or entity that provides healthcare services.
Top 3 Benefits of Outsourcing the Medical Credentialing Process
While the medical credentialing process is vital for a streamlined billing experience and for a high quality experience for the patient, it’s also a tedious and time-consuming process. It involves a mountain of paperwork and can take months to complete; luckily for you, you have the option to outsource this challenging process!
The top three advantages of outsourcing the medical credentialing process for your holistic provider include:
Your H Practice Can Accept Patients with Insurance and Medicare
Being able to accept patients who carry insurance or are supported by Medicare is a game changer for your holistic practice! Medical credentialing helps make this happen; private insurance companies, as well as government programs like Medicare, have an incentive to minimize the costs of their operations and part of this results in only working with providers who are credentialed. Credentialed professionals and providers demonstrate verified competency in their field and, therefore, pose minimal risk. Overall, the medical credentialing process further recognizes and validates your authority to deliver high quality care to members of your community.
It Enables Your Team to Handle Other Important Matters
Chances are you, as well as each member of the team at your holistic practice, wear many hats; this means you’re balancing administrative work with customer service all while delivering great care to your clients. The medical credentialing process is a significant undertaking that would further deplete your team’s time and efforts that might be otherwise better spent elsewhere. By outsourcing the medical credentialing process, you and your team can continue to support every other initiative at your holistic practice while a team of experts handles your important credentialing journey.
It Ensures Accuracy Following the Credentialing Process
What good is completing the medical credentialing process if the application has missing, outdated, or inaccurate information and has to be done again? Not much! Overlooking significant aspects of the medical credentialing application can result in significant delays and overall frustration for your holistic practice. Postponed credentialing means postponed opportunities to serve patients with insurance or Medicare, which essentially impacts your revenue cycle.
Furthermore, each state is likely to have different credentialing regulations and requirements. Not understanding your state’s regulations can also throw a wrench in the medical credentialing process. Outsourcing this process, however, means you don’t have to worry about inaccuracies or misunderstandings!
Outsource Your Medical Credentialing Process with Holistic Billing Services!
Medical credentialing maintains and perpetuates confidence in the quality of healthcare providers and works to keep costs down; medical credentialing is a win-win for everyone involved! If you need to gain or update your medical credentials but don’t want to deal with the headache of completing the process yourself, then let Holistic Billing Services handle it for you!
Our team of experts will ensure accuracy and navigate the process for you so that you and your holistic practice can continue doing what you love: serving your community! Contact us today to learn more!
As a holistic practice, you want to deliver the best treatments of holistic medicine to your patients – while also ensuring you are paid! To service your patients and grow your holistic business, however, you will want to consider provider credentialing as an in-network provider to bill insurance plans. To be approved, you must meet the numerous medical credentialing requirements for your practice. Besides meeting the requirements, you also must ensure that all the complicated paperwork is filled out accurately and the right documentation is gathered.
Don’t be discouraged, however! There are ways to ensure you’re approved the first time you apply for medical credentialing. Here are some considerations to keep in mind so you have everything you need to know before starting the insurance billing credentialing process.
What is Medical Credentialing?
The process of verifying a healthcare provider’s qualifications for administering care to patients to bill insurance providers, medical credentialing is necessary to receive reimbursements for services. Medical credentialing is a common process for most insurance billing, including many commercial insurance companies, medical groups, surgery centers, or government plans like Veterans Affairs, Medicare, and Medicaid.
Generally, the medical credentialing process involves various applications, forms, and documentation, though the exact requirements vary on the insurance provider. Typically, the provider credentialing process must verify that the medical practice’s documents are current and valid. This can include medical licenses, malpractice insurance, DEA, board certifications, and any other additional information necessary to complete the credentialing process.
What are the Common Challenges in the Medical Credentialing Approval Processs?
Although the medical credentialing process is essential to receive reimbursements, there are many potential issues – and ensuing consequences – that can occur. Since provider credentialing is integral to generate revenue, it’s one of the most important processes for a holistic practice. However, data errors, accidental omissions, or any other hiccups in the process can result in incomplete credentialing and possible financial complications.
Medical practices – holistic or not – lose revenue and waste valuable time and money with common medical credentialing mistakes. So, being aware of the common challenges in the medical credentialing approval process can help avoid these costly errors!
Incomplete Applications
A common mistake that plagues medical practices, sending incomplete provider enrollment applications can set back the provider credentialing process for weeks, if not months. The general application for credentialing requires an extensive amount of paperwork and documentation – all that needs to be filled out correctly. Failure to complete the provider credentialing application accurately can result in lengthy reimbursement delays and denied claims that can negatively impact your bottom line.
While some mistakes are inevitable, ensuring qualified credentialing helps eliminate the margin for human error, saving your holistic practice time and money.
Lack of Organization
An organized practice can lead to inaccurate provider credentialing applications, lost paperwork, or extra time spent on the entire process as a whole. Having all your important paperwork and data where it should be and gathered will avoid any issues in the future, such as claim denials or inaccurate physician contact information.
Proper organization can also make the entire medical credentialing process as efficient as possible, so your holistic practice can focus on the day-to-day operations of delivering services to patients and receiving payments.
Not Updating Information
Even after healthcare providers are credentialed, all provider contact information needs to be kept up to date. Depending on the state in which you practice, licenses and credentials need to be renewed regularly. During the re-credentialing process, having up to date information on every individual practicing, including licenses and contact information, will be important for an efficient and accurate process for your holistic practice.
Besides making the process exponentially easier, keeping up to date with physician licenses will also help avoid potential bad patient outcomes if a physician is practicing without an updated license.
Medical Credentialing Checklist for Holistic Practices
To avoid possible claims denials and lengthy issues, you want to make sure your provider credentialing is as accurate the first time around as possible. Since the medical credentialing process can be lengthy and full of complicated documentation, a checklist can help ensure no important data is missing.
Here are some medical credentialing checklists for holistic practices to help provide an accurate and speedy credentialing outcome! Remember that, depending on the state in which you practice, you may have additional medical credentialing requirements that are not fully covered by the process.
Massage Therapy Credentialing
- Know your state requirements for holistic practices
- Provide your NPI (National Provider Identification)
- List all relevant professional licenses
- Provide any evidence of education or training
- Include all board certifications
- Include DEA certifications
- Malpractice Insurance, if applicable
- Current Competence to Practice certifications
Chiropractic Credentialing
- Know your state requirements for chiropractic holistic practices
- Get your NPI (National Provider Identification)
- Licensure: All practitioners must have and maintain a current, unrevoked, unsuspended, and unimpaired license to practice chiropractic in the state where their holistic practice is
- List education or training
- Practitioners must also complete and maintain all continuing education hours as required
- If your practice performs X-rays, make sure to follow radiographic guidelines and x-ray criteria
- Include all board certifications
- Include DEA certifications
- Malpractice Insurance, if applicable
- Current Competence to Practice certifications
Acupuncture Credentialing
These are essentially the basics for acupuncture credentialing in most states in the District of Columbia.
- Graduated from an academic program with U.S. Department of Education recognized accrediting agency
- Passed relevant licensing or certification examinations, or is nationally board certified by the NCCAOM®
- Holds a license in the appropriate jurisdiction
- Education or training
- Include all board certifications
- Include DEA certifications
- Malpractice Insurance, if applicable
- Current Competence to Practice
Turn to Holistic Billing Service’s Medical Credentialing Services to Get Approved for a Network the First Time Around!
Medical credentialing for holistic practices can be a lengthy and complicated process, but one that is an option to receive reimbursements from insurance companies as an in-network provider. An efficient and accurate provider credentialing service is essential for a healthy bottom line, but the process can be full of complicated paperwork that needs to be filled out precisely. By outsourcing your medical credentialing to professionals, you can trust that your credentialing is filled out correctly – the first time around!
At Holistic Billing Services, you can trust our team of experienced billing and coding experts to understand the unique needs of holistic practices and can help you take steps to accelerate your revenue cycle management and avoid claim denials. Since we deal exclusively with holistic healthcare practices like acupuncture, massage therapy, and chiropractic treatments, we are familiar with the medical credentialing approval process and how it affects your business. For any questions about holistic billing, feel free to contact our team today, and let us know how we can help your holistic practice!