Medical Credentialing – Is It Essential in the Medical Field?

by | Published on Nov 25, 2013 | Resources, Articles, Medical Billing (A) | 0 comments

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Are you a medical practitioner desiring to run a smooth practice with minimal risks? Then, medical credentialing is essential. You need to be credentialed and be in par with major government and private insurance carriers. The process of credentialing is time consuming and involves considerable paperwork, but you can have it done easily by outsourcing the work to a medical billing company that also offers credentialing services.

With medical credentialing, the educational history of the practitioner, licenses, residency and additional training are all examined. Special certificates that are awarded to him are also checked. The qualifications of the practitioner should match the norms that are generally accepted in this field.

Given below are steps that are involved in medical credentialing services:

  • The process starts by collecting general information about the qualifications and background of the medical practitioner. Physician credentialing services can be availed of by physical therapists, podiatrists, chiropractors, psychotherapists, nurse practitioners and others, who practice in the medical field.
  • After collection of data from professionals, it would be verified from truthful sources.
  • In the next step, contact is made with the organizations or institutions with which the practitioner is associated. This means that the states that have issued license to doctors, hospitals, schools and other organizations will be contacted. This would make sure that there are no limitations imposed on the doctor. Through this, it can be determined whether the physician has completed the required training and education.
  • After this, the review process would start. This is much beyond just checking the grades of the practitioners at medical school. The process would evaluate their performance throughout their career. In this, the malpractice history and coverage, personal conduct history as well as hospital privileges are examined.
  • With every state, insurance company or hospital, the process of medical credentialing gets complicated. Since this is very complex, companies that are specialized in offering credentialing services can be of great support to physicians.

Why Physician Credentialing Is Beneficial

  • Receive better payment: reputable payers provide better reimbursement to physicians who are credentialed.
  • Better quality healthcare: physician credentialing ensures that providers are qualified and experienced. It helps to ensure better quality healthcare to patients and prevent healthcare frauds.
  • Credentialed physicians get more patients: patients prefer to be treated by licensed and authorized physicians.
  • Can opt for the best fee plan: insurance carriers allow credentialed physicians to choose the best fee plan. They are also provided access to the correct fee schedule for various medical procedures and services. This enables them to claim the correct reimbursement.

Credentialing services provided by a reputable medical billing company are immensely helpful to medical practitioners. Associate with a firm that ensures customized services within the required turnaround time.

Outsource Strategies International.

Being an experienced medical billing and coding company in the U.S., OSI is dedicated to staying abreast of the latest industry guidelines. Our services provide comprehensive support for the success of your practice.

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