Credentialing a Catch-22?

Updated: Mar 3



Credentialing new physicians can sometimes be a struggle and often a catch-22. The process cannot be started to early since some payers won't accept the application if they the physician does not have their malpractice in place. Often when the payer does accept the application the new physician is already on board and ready to start seeing patients. This can be bothersome to the practice since credentialing typically takes 3-6 months if not longer…

Things not to do while waiting for credentialing:

Do not employ the strategy of billing the new physicians services as if an existing physician provided them. This is risky because:

  • The enrolled physicians utilization is going to spike

  • If the patients sess the name on the EOB they might call the insurance plan to say “that's not the doctor I saw”

  • The payer might request your appointment schedule

  • Red flags like these will likely trigger an audit, audits should be avoided at all cost.

Things to do while waiting for credentialing:

Ask for a statement of supervision

  • Some plans will allow you to bill under a supervising physician once the credentialing process is underway. Just make sure to ask if the plan will accept an statement of supervision from physician enrolled in the plan, this is a good way to get a new physician to start seeing patients.

Divert self-pay and medicare patients to the new physician

  • Physicians can see Medicare patients right away, medicare lets physicians retro-bill back 30 days from the date of their application.

Speaking Engagements

  • Put the new physicians on the speaking circuit. This is a great way for them to meet other physicians and get to know the community.

#Medicare #Credentialing #healthcarebilling

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