EVERYTHING YOU NEED FOR A NEW VENTURE… Experts for credentialing and contracting for making your business profitable. Part 1/6
How it all works! Important Tips
Starting a new business venture for a provider who is just out of medical school can be an exciting step to practicing medicine outside of the educational venue Fellowship, Residency or Internship. You now have the needed Medical Education, Medical License and Board Certification to begin treating patients. The next obstacle is where do you want to practice based upon the training you receive. When you get to the area you chose to practice in, you must decide if you want to join an existing group to build your patient population or do you want to take the risk of assuming the full scope monetary burden of funding your own practice until you are financially sound. Another decision is what insurances should you accept for maximum reimbursement?
Think of each application we do as an employment application. You might say to yourself, wait I own my own business I am a physician I am licensed to practice medicine, I have the appropriate training and a board certification which shows I am a sound professional who can see patients under my particular specialty. What the insurance company needs is that information quantified into applications, credentialing verification’s (background checks) and a whole list of information from your practice location, services, treatments and demographics. They will then use the information provided on an application to search through all of your credentialing background to make sure that you are the right fit to see their members (your future patients) according to their Credentialing Guidelines & CMS Contracts. If any of the information is incomplete or incorrect your application will be rejected. This in essence equals- no credentialing / contracting, no patients assigned to your office and no revenue generation. The average credentialing & contracting turnaround time (if all the planets align, perfectly) is about 120+ business days. This means you get to open a new practice and float the cost of staff, equipment, and services for 4+ months until the processes are complete with no real guarantee that what the payer indicated in the application is needed is what you supplied. If the credentialing files at any point in the process are incorrect, they can be declined & the health insurance company will start you back at Day 1, regardless if you are 89 business days into your application process. Keep in mind that most practices are participating with about 10-15 insurance companies and each insurance company has its own in-depth process & application which can average to about 5+ hours per application. The average turnaround time given is based upon a perfect credentialing file, the more accurate fair time line is 180-365 business days. Hiring a Credentialing & Contracting company to wade through this tedious process can save you 50% on the time it takes to process the application & contract. This equates to processes being done right the first time and revenue sparking to ignite the true potential of your growing practice.
Most professionals decide directly out of school to open a practice immediately, they sign a lease, turn on the power, prepare their patients rooms and open the door. The problem these practices run into is revenue flow. If you don’t have any contracts you have paid a significant amount to run an office, staff and you have no patients coming into the office because you do not yet accept their insurance. Ideally all credentialing should start about 90 business days in advance. Right at the point where the lease is signed and the phone # is determined by your carrier we should begin the process. When you wait you lose money.
Each payer processes applications in a different way, i.e., electronic online, mailed application or email request. Regardless of the mode of application there are daily blunders that occur at all payers regardless of government (Medicare / Medicaid) to Commercial Payers (Blue Cross Blue Shield). All of our paperwork goes to 1 department or another to be funneled through multiple departments for their portion of the process. Most payers are understaffed and overwhelmed and losing paperwork. Incorrect filing, and incorrect data entry introduces a whole new host of unforeseen delays.
The only solution to these delays is constant vigilance through calls, emails and countless reapplications until your application is processed. Many offices do not have the time or resources to do the tedious task of following up on every payer every day. CredAxis is perfectly equipped and knowledgeable about the payer processes and knows precisely where these mistakes happen and how to effectively communicate to avoid these delays. Physicians are rarely educated in school about the administrative nightmare credentialing & contracting, can be and what precisely is really required. From hospital privileging to contract set up CredAxis has the process down to an absolute formula and can lend some of our knowledge as to what is required to maintain or start a practice at Day 1 saving the time, money and aggravation to allow physicians to practice medicine. Over the next few weeks we will share some key tips for credentialing & contracting, Starting Corporation documents required for your business, Individual Credentialing Documents, how to choose the right payers for your practice, CAQH Set up, to contacting the payers for the contracts.
CredAxis has highly experienced credentialing experts armed with innovative, practice focused solutions to help your practice be compliant and successful from day 1.