Credentialing Woes, A Cautionary Tale

One of the hallmarks of early spring is the weather that is all over the place. The weather is warm and beautiful, and you finally put all the flowers and vegetables into the ground, only to have frost warnings a few days later. Of course, the age-old saying “April Showers bring May Flowers” tends to ring true. And sometimes, those showers…well, they turn to storms.

That is what it can be like when you start your practice. The clinician is full of hope, excitement, and optimism.

Just like spring weather, it can be up and down. It’s not uncommon to have some frost, and occasional severe storms. It can feel as if the ground will open up beneath you.

This is more likely to be the case when you don’t have good reliable information and guidance. We may rely on people who don’t truly understand the business of healthcare. As well-intentioned as they might be, there may be some that lack information, or have a misunderstanding of what is need.

Worse there are people who say they can help you…and are not honest about what they will or can do.

Case in point

This past week, a Nurse Practitioner was about to give up her business, just as she was getting started. Her practice looked promising, she had patients and was seeing them. But not all was rosy. She was working with someone to do her credentialing and billing, who either did not know what they were doing or misled her (intentionally, or not).

Fortunately, she reached out for help to several people. The person she was referred to, contacted me as well.

The problem

This NP hired someone to do her credentialing and billing. Over 6 months ago. To her knowledge, she was still not credentialed and was not getting the information she needed from the business who promised they would take care of it. This biller told her not to worry, they were waiting on contracts and she could start seeing patients.

This NP had not seen a single contract, let alone sign any contracts, and did not know who, if anyone she was credentialed with. Of course, no billing was taking place and her savings were dwindling.

One of the people she contacted was Don Self. He referred her to Kathie Lloyd. That name might be familiar as Kathie is the biller who did our most recent webinar.

I have to say, it was truly amazing to see how tenacious Kathie became to try and find out exactly what was going on and make it right for this NP.

In the meantime, I spoke with this NP to see what else she needed to be successful. At that point she was truly ready to throw in the towel that day. However, with support, mostly from Kathie she is moving forward and will be just fine. In fact, I expect her to have a very successful practice.

There are several lessons here for many of us. The NP who is the subject of this article would love for you not to make the same mistakes.

Take-a-ways

  • Do NOT allow anyone to sign contracts in your name! (Yes, that happened!) There are many reasons for this, but as Kathie pointed out, that also means they can cancel the contract without notifying you! This is like signing the rights to your business away.
  • Read your contracts! You should never sign a contract, with anyone, without understanding what you are signing. If you are unclear, there are multiple attorneys you can use. Carolyn Buppert (author of the Nurse Practitioner’s Business Practice and Legal Guide 7th Edition) will review contracts.
  • Always have full transparency from the person you have hired. Who are they speaking with and what are the phone numbers? What is being said/done? Where are things in the credentialing and or billing process?
  • Stay in touch with them! Credentialing, in most cases does not take 6 months! Again, what’s holding things up? Are there additional documents that are needed? Is there other information that is lacking? Silence is not an acceptable answer if you want to work with this company.
  • Understand the credentialing process. While it’s relatively easy to do on your own, sometimes we just want someone to do it for us. Fine, but understand what’s going on and what to expect. That’s one of the reasons we created a credentialing course. Knowledge is power.
  • If you are going it alone, fine, but reach out when you are running into problems. Don’t let it get to the 11th hour.

There is a lot of support available for NPs and others who want to start a practice, from out company as well as others. Always do your own due diligence when contacting an “expert”…because not all of them experts, and as in this case, we’ve seen too many in our community get the short end of the stick.

In fact, one of our former NPBO™ member recently expressed her dismay of the “business owners” who are dishing out erroneous information in the public business Facebook group for NPs.

We must support each other. The more NPs that are successful in their practices, the better it is for everyone.

About Kathie Lloyd

If you’ve been following me for any length of time, you know that I’m reluctant to recommend anyone for billing. We’ve all seen too many who start out strong only to fade away. However, at this time, I do feel I can confidently recommend Kathie.

Kathie is a certified management accountant, certified fraud examiner, and certified professional coder who has been in business for over 20 years. She and her team of billers are all US-based and work with general practices as well as specialty practices, and yes, that includes psych.

Here is her contact information. (I get nothing for the referral except thanks and maybe we’ll be able to twist her arm to do a future webinar).

Kathie Lloyd, CMA, CFE, CPC
TRI-CITY PHYSICIAN
NPI # 1629244744
Phone: 844-458-8188
Mobile: 804-243-0716
Fax: 866-898-6066
www.tri-cityphysician.com (being updated)

I invite you to leave your questions or comments below!

Comments 5

  1. OMG! I feel your pain completely! I would like to talk with you about the nightmare called credentialing.

  2. Credentialing can be a nightmare, especially in some states. I went to a cash based NP business for that reason.

  3. I own the Country Doctor in Peoria Arizona. My complaint, I want 100% of pay for my services not 85%! I pay 100% of over head, billing, malpractice, employee pay, medications, paper, ink, you name it. I don’t get to pay 85% of what I need to run my practice. No one gives me 15% off my bills. The reason for this importance? Because NP’s already and remain in a discounted financial hole. Why should we accept 85% from insurance companies yet they expect and hold us accountable 100%? NP’s working for MD owned practices are billed under MD’s for 100%. Why are we as a profession getting screwed right out of our own goals and achievements within the communities we serve?? We have to and must come together as a profession and demand we receive full compensation for our valued work!! The process of Credentialing needs to be made NP friendly by THE insurance companies KNOWINGLY take advantage of us given their members will receive outstanding quality care for a mere 85%. Peoples, we need to look at the bigger picture if we all want to succeed. Is your work 85% completed or 110%? Can you do 85% of your diagnosis, notes, follow-up, worrying you made the right decision for your patient? I think NOT! Then why are we allowing insurance companies to pay us less for our commitment and the work we do?

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