Headaches in private practice…? Surely, I must be kidding?
No, I’m not joking… running your own practice comes with a few headaches. And while most practice owners see them as problems, others view them as challenges. It all depends on your point of view.
But no matter what you call them if you’ve been in practice for any length of time, you’ve come up against them.
And while every clinic and provider are different, there are a set of “challenges” universally experienced by practice owners.
What exactly are they? They include:
- Getting paid for your work from insurance and patients.
- Creating consistent and reliable cash flow in your practice.
- Getting and staying credentialed.
These challenges don’t exist in a vacuum. To some degree, they’re interconnected, and each has the power to make or break your practice!
What do I mean?
- Getting paid… if you don’t get paid for your work, your cash flow will suffer, and you won’t be able to stay in practice for long. And it doesn’t matter if you’re an all-cash practice or credentialed with insurance.
- Creating consistent cash flow… late or no reimbursements/payments, translate into roller coaster cash flow, leaving you wondering how to pay bills from month to month.
- Getting credentialed… if you have problems getting or staying credentialed, you may lose valuable time, income, and patients.
A few weeks back, I started this series with a discussion on getting paid, followed by another article focused on getting to consistent cash flow.
Today, let’s talk about the challenge of getting and staying credentialed.
If you operate a cash only practice, feel free to click away; chances are don’t need this information. But if you work with or consider signing on with insurance companies, read on, because this article is for you.
What is Credentialing?
Most often, credentialing refers to insurance credentialing. While not all insurance companies may require you to complete a formal credentialing process, the majority does.
Judging from the questions we’ve received over time, there is some confusion about the difference between insurance contracting and insurance credentialing. The two are not the same.
Credentialing is a process utilized by insurance companies to verify your identity, professional education, experience, and competency.
Additionally, insurance companies will scrutinize your background for malpractice claims, lawsuits, complaints, addiction issues, and the like.
Once the insurance company “credentials” you, it means you have met their requirements and are qualified to join their network of providers.
Contracting is what happens after you’ve been credentialed. Once you’re credentialled and their panel is open for new providers to join, you become part of their “panel.” You now can treat their members in your office and bill the insurance company for your services.
You would sign a contract, outlining the terms of responsibility for both the company and you, the provider. Think of credentialing as the vetting process and contracting as the terms of agreement.
For the most part, getting credentialed is a straightforward process. The insurance company has a set of requirements, and you need to meet them. It means providing them with all the necessary documentation they request from you.
But if getting credentialed is so straightforward, why is it many providers are overwhelmed by the thought of having to get credentialed? And why do some turn to third parties to do their credentialing for them?
By itself, getting credentialed is not that difficult, but there is “the hassle factor!” Getting credentialed and having to get re-credentialed can be challenging because:
- It can be time-consuming to fill out all the forms
- It’s a tedious process, and there can be lots of detail to track
- It’s an inconvenience if something is to go wrong
But we’ve heard from a number of NPs who hired out the credentialing but didn’t get what was promised to them.
In some case, the company either didn’t do it right, never finished the credentialing and in some cases never even started. If this should happen to you, it means you’ll have to start over from scratch, losing precious time, money, and income.
And of course, there are companies who do a good job and get you credentialed; but be prepared to pay a pretty penny.
But regardless if you hire a company or if you decide to do it yourself, it’s you who will do the heavy lifting. Because in the end, it’s you who needs to supply most of the documentation.
And if you fill out the paperwork completely and correctly and submit it as requested, there should be no, or minimal issues. Also, there shouldn’t be time between sending the application and getting credentialed.
But there will be problems when things are not done correctly or send in incomplete.
Here are a few things to keep in mind when starting your credentialing:
- Make a list of all insurance companies you want to work with.
- If some don’t use a service like CAQH, find out their specific credentialing requirements.
- Work on pulling all your credentialing documents together.
- Fill out and submit all required applications and documents.
- Follow up on your application; you want to respond at once if anything is missing.
Once you have all your documents together, keep them together and up to date. The next time you’ll need to credential or re-credential, it won’t be much trouble at all.
If you’d like assistance with getting credentialed, we have a resource to help you get it done: “DIY Credentialing: Get It Right The First Time And Save A Bundle!”
The most crucial part of this entire process is to gather all your documentation. Keep everything up to date and in a central place. Because with many of these documents, you’re the only one who can supply them.
Have you done your own credentialing? Have you outsourced your credentialing? Either way, share your experiences, so we can all learn from them! Just leave your reply below this article…
By Johanna Hofmann, MBA, LAc; regular contributor to the NPBusiness blog and author of “Smart Business Planning for Clinicians.“