Author Archives: ercule

Medical Practice Staffing: Best Practices & Beyond

Any physician knows that the business side of medical practice has been tough in the past few years. Hundreds of thousands of jobs have been lost. For many hospitals and private practices, revenues have plummeted. Healthcare practitioners are burnt out. And demographic shifts are leading us toward a major nursing shortage.

Medical practices right now are faced with tighter budgets and fewer job candidates. On top of that, as jobs are lost, so is the longstanding practice knowledge that those employees had. Constantly training new employees because of high turnover has become a major time investment for many practices.

Still, every medical practice needs talented, passionate staff. Here’s how you can find them – and convince them to work for you.


Respondents were asked whether they’ve considered leaving their job since the beginning of the coronavirus


Audit your practice first

Before the recruiting for a new hire begins, take the time to get a clear look at the current operations. This is an opportunity to improve everyone’s work life.

Consult with current staff

Each person on your staff has a unique role and a unique perspective on the business. They know your practice as well as anybody. This is an opportunity to gain their insight on specific questions:

  • What support do they expect from a given position?
  • What were some of the challenges faced by the last person in that position?
  • Are any current staff interested in any of these available responsibilities?  

Take fresh inventory of your budget

Investigate your budget in a holistic way, with an eye toward optimizing current operations and creating new positions that will keep the practice growing and innovating:

  • How much have you earmarked for a given position? 
  • Does that include the costs of materials and tech that the position requires? 
  • Is it possible to shift some roles to a more cost efficient position or outsourced solution?

Consider restructuring

A new hire is a new opportunity to optimize your operations. So before hiring a new person to fill an administrative position, analyze the responsibilities of that position. 

  • Would any current staff be better suited for a given task? 
  • What tasks could be automated or outsourced?
  • What new duties and services might a new hire bring to the business?

Invest in Human Resources

There’s a reason why hospitals and other large medical businesses have entire departments devoted to HR: it’s fundamental to overall success. If you give the staffing the respect that it’s due, you’ll see better long term results

Prioritize the process

For tiny independent physician practices, you may not have the budget (or need) for a full-time HR person. But you do need to allocate time and money to the process. Based on your available resources, consider allocating

  • Staff members to share responsibility for the process
  • Time to focus exclusively on the staffing project
  • Money for recruiting agencies

Target your recruitment

Looking for nurses? Seek out nursing associations that are active in your region. Trying to recruit administrators? Looking for a specific technical or administrative skill set? Consider platforms tailored to those groups, such as Linkedin.

Find competitive salaries

When it comes to finances, candidates do their research. If you want competitive candidates, you need to offer a competitive salary. Do your research for related compensation:

  • Benefits
  • Paid vacation time
  • Schedule for pay increases

If possible, you should aim to be competitive in all of those categories. If finances feel tight, look for tasks that can be automated or outsourced, eliminating unnecessary labor hours.

Embrace the benefits of tech and managed services

Staff members fall ill from time to time. They take emergency family leave. It’s part of the human condition, as the COVID-19 pandemic made painfully clear. Respecting this fact is essential, but the disruption caused by staffing fluctuations can be avoided.

Crucial administrative tasks can be assigned to software platforms. Automating tasks with tech is like hiring an employee who never needs to take a sick day.

Work with a healthcare partner to manage services

When you work with a skilled partner, you can free up your current providers and staff to focus on the high-value work that they do best. At Quatris Healthco, we empower practices with athenahealth technology and take on burdensome tasks to reduce your staff’s administrative workload and offer your patients the conveniences that today’s consumers expect.

We help practices streamline their day-to-day workflows in many different ways, including:

  • Onboarding and training support
  • The creation and maintenance of practice created rules and templates
  • Running financial, clinical and operational reports
  • Hands-on hardware and software support

Automate your revenue cycle management

You know how essential the Accounts Receivable team is to a medical practice. To attract the best possible candidates, consider automating your revenue systems. By removing the rote tasks from a job description, you can attract more experienced, ambitious hires. 

Automation is the key. A revenue cycle management platform takes over some of the most laborious steps in revenue cycle management:

  • Tracking changes to payer requirements
  • Submitting and optimizing claims
  • Sending bills and reminders to patients

Revenue cycle platforms also empower patients to pay their balances directly, via online portals, freeing up the inboxes, phone lines, and work hours for your team members. 

Keep your current staff happy

Employee churn is expensive – the cost of recruiting, hiring, signing bonuses add up. On top of this, the lost revenue and unseen patients that result from being understaffed. One of the best ways to improve your staffing is to keep your amazing employees on staff as long as possible.

Promote professional growth

Your staff is brilliant. Keep them engaged by giving them the challenges that satisfy them at work. 

  • Encourage (and pay for) continual trainings
  • Give people opportunities to take on more skilled roles
  • Find mentors for ambitious staff

Maintain a positive workplace culture

As demanding as the medical profession is, your practice can still be a place that energizes its staff. Like any vital piece of infrastructure, the culture of your practice needs active maintenance:

  • Celebrate successes
  • Discuss the shared purpose, and the joy it brings clients
  • Schedule check-ins with every staff member

Support your staff beyond the paycheck 

Show your team that you see them as more than just employees. They’re complex people with busy lives. Find structural ways to show this belief:

  • Build flexibility into staff scheduling
  • Encourage people to take vacation time
  • Schedule family-friendly social events

The Future of Medical Practice Staffing

Hiring is as difficult as ever. Your practice can still win amazing candidates – so long as you’re prepared to be an amazing employer.

Before you create any job listing, take a clear-eyed look at your business – its budget, its workflow, its growth opportunities. Make space for the hiring process to stand on equal footing with any other ongoing workplace service. And encourage a culture of mutual support, respect, and inspiration throughout the practice.

This might require a revision of longstanding systems in your business. It might mean updating systems to free up your staff to focus on the more important work. Discuss the possibilities with Quatris Healthco.

How to Reduce Your Patient No-Show Rates

No-shows cost the healthcare industry an estimated $150 billion in profit each year

When a patient unexpectedly misses an appointment, the consequences can be ruinous for their health. For your medical practice, a high rate of no-shows can compromise revenue and, ultimately, the quality of care you provide.

Not only does it waste valuable time on the clinic schedule, it also discourages patients from ever making up their appointment. If a patient no-shows, there’s a strong likelihood they won’t visit their practice again for 18 months

Every patient misses an appointment now and again, but last minute cancellations are avoidable. Let’s take a closer look at no-shows, and how to mitigate them.

Why patient no-shows are dangerous

It’s easy to overlook the occasional no-show in a day’s work. However, the trend has far-reaching consequence for any medical practice – and its patients.

No-shows harm patients

When patients miss their appointments, they often fail to reschedule altogether. As every physician knows, delays in medical check-ups and procedures can lead to severe health consequences for any patient.

No-shows illuminate bigger issues

No-shows are the result of some systemic shortcomings, be it communication, staffing, patient engagement, or tech infrastructure. These same systems can also affect, and inhibit, revenue cycles, employee satisfaction, and overall quality of care. By reducing no-shows, you’re also optimizing the fundamental systems of your business.

Profit loss adds up fast

A time slot that goes unfilled in a practice results in an estimated $200 in profit loss. Ten no-shows in one week could amount to an upwards of $2000 profit loss. Over the course of a year, that is potentially a six-figure loss.

No-shows affect all specialties

One study across primary care and sub-specialties found the average around 18% – however, some practitioners report much, much higher rates. It is an inevitable part of any service business. How your business mitigates no-shows is really what matters.

Reasons for patient no-shows

There are myriad reasons why individuals miss their medical appointments, but often they fall under one of a few common categories. Identifying them is the first step toward mitigating their effects.

Transportation

Every year, millions of people miss doctors appointments because they don’t have access to adequate transportation. While this may be particularly extreme for rural practices, travel may be a prohibitive factor for people with disabilities in any area.

Finances

Though the Affordable Care Act has increased the number of insured Americans, many people struggle to pay their bills. The prospect of another expense – even a crucial medical check-up, at insured rates – can cause people to cancel appointments.

Apathy

It’s easier to cancel an appointment if it doesn’t seem important. Physicians understand that routine medical check-ups and preventive medicine save lives – but that relationship is not always made clear to patients.

Forgetfulness

Sometimes people just forget. In fact, more than ⅓ of no-shows were people who simply forgot, according to one study. If they scheduled their check up six months ago, and haven’t been reminded about it since, it’s all too easy to forget.

Rescheduling obstacles

Some no-shows are people who wanted to reschedule but never managed to successfully do so. Rescheduling over the phone might be inaccessible to some clients due to scheduling or language barriers. An overwhelmed reception desk might simply not be able to handle all callers.

Tips for decreasing patient no-show rates

No practice can ever get to 0% no-show rates, but most practices can aspire to lower their rate significantly from its current levels. How intently you mitigate the no-show rate is up to you.

Waitlists

When the inevitable cancellation arises, you can still fill that appointment slot. Keep a waiting list for every day, so patients can make use of the opportunity – and you can keep the schedule full.

Telehealth

For patients with disabilities and transit access issues, telehealth can mean the difference between seeing a doctor or not. It also allows physicians to geographically expand their client base and fill in empty slots on short notice.

Reminders

Send multiple reminder notices, to every patient, especially as the appointment date approaches. Remind them not only of the time and location but also the reason for their appointment, and how it fits into their overall well being. If possible, send them via the patient’s preferred mode of communication – email, text, app, phone, or even postal mail.

Automation

By automating all scheduling correspondence and reminders, you’ll eliminate the chance for human error and allow your reception staff to focus on higher-touch patient engagement.

Patient portals

Empower patients to make, cancel, and reschedule appointments on their own with an online portal. They can amend appointments any time of day or night as needed, saving your reception desk time and giving patients greater ownership over their own care.

Conclusion

No-show rates are the cause of avoidable health complications for patients and unnecessary profit loss for medical businesses. The reasons for no-shows often come down to personal obstacles for patients and communication errors on the part of medical businesses.

By streamlining patient engagement operations and taking a more active role in the scheduling process, any practice can decrease their no-show rate. Building greater accessibility into the scheduling process as well as medical treatment will ensure that more patients can make it to their appointments.

The infrastructure required for these improvements is available to medical practices of all sizes. To explore them all in one unified platform, reach out to the Quatris Healthco team today.

Revenue Metrics for Physician Practices

Revenue metrics can provide insights far beyond basic profit margins. Patient engagement, insurer relationships, human resource management, and infrastructure can all be optimized with a more robust revenue metric model – so long as you can effectively track the revenue cycle data.

Why revenue metrics are important

The more refined your revenue management, the stronger your practice will be – so your patients receive better care and your staff feels more inspired at work. But the path to achieving this is different for every practice. 

Depending on your specialty and patient demographic, your business might need to operate in a radically different way from those of your colleagues. 

Benefits of tracking revenue metrics

When you track your business’s revenue data, you’re getting a more clear view of how your practice actually operates – and how that differs from the ideals you set – so that you can lead everything toward greater harmony.

By streamlining workflow, you’re freeing up your staff to work on higher priorities and more challenging projects. By removing reimbursement obstacles, you’re creating a better experience for patients and ensuring the longevity of your practice.

Effective practice metrics require strong data

Before you get started tracking revenue metrics, make sure the data you’re working with is accurate and current. Hopefully, your accounts receivable department has accessible files for each patient’s account – and ways to track composite data as well.

If you’ve got an in-house spreadsheet wiz, then spreadsheets will suffice. But when compiling this data, take note of how well the organization suits your purposes. An online management platform might better serve you.

Practice revenue overview metrics

Macro-level metrics show how well you’re covering the financial and operational baselines. 

Collections

These are the major accounting metrics that are common to most any Accounts Receivable department. If your practice is already up and running, you’re probably tracking these too:

  • Total charges
  • Payments
  • Total accounts receivable
  • Claim volume
  • Collectible vs non-collectible adjustments
  • Collections rate
  • Collections per visit 
  • Days to insurance payment
  • Bad Debt

Questions to consider with these metrics: How exactly are you collecting them? How often are they being updated? And how many labor hours go in to the calculations?

Processing 

Collecting data around your billing process will empower you to optimize it on the admin side. This applies to claim workflow as well as patient intake. 

Processing metrics can include:

  • Average number of days to charge posting
  • Statement count 
  • Number of patient visits 
  • Patient no-show rate 

Troublesome patient no-show rates likely point to a scheduling or patient engagement issue. Long delays between patient visits and charges posting may indicate workflow problems in your billing department. 

There are plenty of simple solutions to such issues. Identifying the problems is sometimes the bigger challenge.

Revenue cycle metrics

Revenue cycle metrics provide a more granular view of financial operations.

Aging Invoices

Invoices age allows you to see how outstanding payment is from patients and insurers. Typically, aging is broken out into 30-day clusters:

  • Aging 0-30 
  • Aging 31-60
  • Aging 61-90 
  • Aging 91-120 
  • Aging 121-360 
  • Aging 361 Plus 

The majority of your invoices are probably in the Aging 0-30 category – that is, your outstanding invoices are almost entirely the new invoices. The percentage in each age category should drop steadily from there. Ideally, the Aging 91-120 group should account for less than 10% of total invoices.

With older claims, it’s important to be proactive in trying to collect. But it’s also worth analyzing the claims themselves. In any particular later-age group, you might find certain commonalities: maybe they’re all appeals with a particular insurer, or awaiting refunds from your own office. Sorting this information will be key in optimizing your revenue cycle.

First Pass Acceptance Rate

This will show you how frequently claims go through with no additional attention required. It’s a metric worth focusing on, as it affects revenue as well as labor costs. A rate of ~90% is really the goal – though it’s common for practices to be somewhere around 70%. 

There are plenty of unique reasons for a claim rejection. Here are just a few of them:

  • authorization time-outs
  • improper coding
  • patients switching insurance plans
  • absence of referral documentation

But first acceptance rate issues really point to structural problems in your billing process. Somewhere along the workflow, there is a continual failure to update and track the necessary information.

Are Your Practice Metrics Healthy?

The revenue cycle of a physician’s practice is a window into its overall operational health. In order to assess that health, you need the clearest view possible. This means accurate, updated data and analysis on granular levels, as well as the macro bottom-line metrics.

These metrics will show you which of your systems need the most attention. The data for these metrics already exists in your Accounts Receivable departments – the trick is to identify it, track it, update it, and analyze it. 

That’s where a revenue cycle management platform comes in: automating these billing and data processes while making sure you stay up to date with changes in insurer policy and legal protocol. Quatris Healthco provides technology and services to help your practice thrive across each of these metrics – explore your options today.

Physician Credentialing Checklist

For any physician looking to expand their client base, physician credentialing is a crucial business step. Credentialing enables you to work within insurer networks. Billing in-network simplifies the revenue cycle and opens you up to more potential patients.

It’s a standardized industry practice – but that doesn’t mean that the process is simple – It’s time-intensive, meticulously detailed, and each insurer’s requirements are slightly different. One error in an application can delay the credentialing process weeks or even months.

This checklist will help you visualize and track the main steps in the physician credentialing process.

Physician Credentialing Checklist Steps

Research

Determine which insurer networks are viable for your practice – and which fee schedules appeal to you.

  • Research private + public insurers
    Nationwide insurers will be the easiest to identify and vet for your credentialing.
    • Medicare
    • Medicaid
    • Commercial insurance
  • Research local insurers
    Smaller, regional insurance networks often have sizable client populations. There are a few ways you might find all available options:
    • Ask local colleagues
    • Consult ACA exchange websites

Determine a workflow

This process is time-sensitive and has a lot of moving parts. Figuring the order of events and methods ahead of time will ensure success.

  • Scheduling
    The process can take anywhere from 60 days to 6 months. Anticipate the schedule so you can hit the ground running as soon as the credential is approved.
    • What is the turnaround time for each application?
    • When will you submit the application?
    • When will you follow up with the companies?
  • Materials
    Each application is unique, and insurers often update the protocol for their applications. Find the most current information for the following fields.
    • Documents
    • Contact information
    • Relevant notes about the process
  • Delegation
    Someone will need to file and track this application. Who will it be? Here are ways to figure out the best fit
    • Determine the cost – in labor hours – of managing the application yourself.
    • Determine the cost – in labor hours – of assigning the task to an admin person.
    • Research third-party service
      • Ask colleagues for recommendation
      • Assess criteria
        • Cost
        • Success rates
        • Customer reviews

Assemble documents

Every application is different, and each should be given equal care. Some important documents will likely be required for each application. Prepare to organize the following documents.

  • Medical practice documentation
    • IRS forms (eg. W-9, CP575)
    • Business license
    • Copy of lease
    • Bank account verification
  • Physician documentation
    • Education
    • Certification
    • Licenses
    • Work history
    • Clinical privilege history
    • Peer references
    • Insurance claims history

Submit application

This step goes beyond simply pressing the ‘Submit’ button. A single error in your application can delay it for months – and a delay in credentialing is a delay in reimbursements.

  • Verify requirements for each application
    Double-check the list of necessary documents. Make sure you’ve supplied each one according to specifications.
  • Double-check for errors
    Make sure you’ve done so according to each application’s requirements.
  • Submit
    When you’re confident your application is error free, finalize the submission.

Track progress

It’s important to be proactive in the time after you submit the application. If there is a complication with the application, you’ll want to know as soon as possible. The best way to ensure that is to check in regularly with each insurer.

  • Document contact info for each application liaison
    Locate the applicant liaison at each insurer.
  • Create follow-up timeline
    Schedule update communications to go out for each insurer. We recommend contacting them once every 3 weeks.
  • Reach out
    Contact each insurer according to your schedule. 

Physician Credentialing Services With Quatris Healthco

If you’re starting a new practice and looking for a partner to help you meet your credentialing needs and beyond, we’re experts in getting practices set up for success across the board. Our physician credentialing service helps medical practices across the country minimize mistakes and maximize their collections.

Learn more about the credentialing services we offer, or reach out to us today to find out how we can help.

Starting A New Medical Practice: Checklist & Best Practices

So you’ve secured funding, picked a location, built out a beautiful space for patients to receive care. You’ve got a lot of details to manage in the coming months.

This checklist is designed to support you in covering all the fundamentals for a practice that is safe, secure, efficient and profitable – together enabling you to provide the best possible care for your patients.

Legal

Governmental certifications and licenses that are necessary to opening your business.

General Business Requirements 

  • Business structure – The structure you choose will have far reaching effects on your daily business, profits, liability, and more. The U.S. Small Business Administration is a great place to start researching your options.
  • Fictitious business name – Most businesses require this, unless the name of the business will be exclusively the name of the sole proprietor. Generally, the name will be registered with the office of your local county government.
  • Business license – This will be acquired from the office of your local county and/or city government.
  • Employer Identification Number – You can register this with the IRS.
  • Insurance – Requirements vary by state. Some types of business insurance to consider:
    • Worker’s Compensation
    • General liability
    • Group disability

Specific to Medical Business 

Insurance Contracting

Establishing insurer network partnerships early will improve your revenue cycle and expand your patient base. Here are the main steps to getting started.

  • Credentialing & Privileging – To join insurer networks, you’ll need to apply for credentials with each, then specify privileges for which you’ll contract. For more about this, read our in-depth blog on medical credentialing.
    • Research all viable insurers in your area
    • Submit & track applications for chosen insurers
  • Fee schedule – Determine thoughtful system of fees for each of your services, based on research determining reimbursement rates from all payers – commercial, Medicare, and Medicaid.

Data Systems

Practice management tools are necessary to maintain patient care, legislative compliance, and a welcoming workplace atmosphere. Research and contract data systems that fit with your practice’s resources and needs.

Staffing & Training

A strong team is the backbone of any successful practice. You’ll need to establish infrastructure and protocols to build and sustain a happy staff.

Role delegation structure

What positions will your practice require?

  • Licensed personnel – Positions such as physicians, nurses, associated specialists
  • Unlicensed personnel – Positions such as front desk, bookkeeper, facility maintenance

Payroll

  • Salary – Designate salary ranges for each position.
  • Benefits – Designate benefits for each position. Choose an insurance provider.
  • Payroll service – Depending on the size of your practice, you might elect to handle payroll in-house, though many practices find a third-party more beneficial.
  • Recruitment & Hiring – Promote job openings in trade forums, social media, and with friends in the local industry.
  • Training – Standardize the tasks for each hired position. Account for every essential task. Make sure that all fits within legal requirements as determined by federal bodies such as
    • OSHA
    • HIPAA

Marketing

A beautifully engineered business deserves a robust outreach campaign. People deserve to know that you exist! 

  • Industry Networking – Visit local and regional industry events. Reach out directly to complementary medical specialists in your area. Promote yourself to people in adjacent industries, such as fitness or wellness.
  • Patient Outreach – There are limitless possibilities for promoting yourself to the public. Make sure you try at least a few different platforms. A few to consider:
    • Social media – Instagram, Twitter, even LinkedIn
    • Online – Google ads, online review sites like Yelp
    • Events – Sponsor local community events or host your own

Conclusion

You already know that starting a business is a huge undertaking. Remember: covering all details at the outset of the process will save you time, money, and stress in the long run.

Focus on registering and licensing with federal and state bodies first. Move on to insurance partnerships as well as info systems contractors. When it comes time to hire people, make it as easy as possible for them to join the team and succeed. Promote your business far and wide, in person and online – not just once, but continuously, in a sustainable way.

And if you’re looking for a partner to help you manage the credentialing process and offer support and implementation of word class practice solutions, connect with our product specialists today.

Medical Credentialing for Physicians & Practices

Whether you’re opening a new practice or first establishing yourself in the profession, you’ll almost certainly need to be credentialed with insurers. Credentialing is a step toward partnership with any insurer. It’s a way to secure vital revenue streams. And it’s a way to ensure quality among all new physicians you hire.

Practices and hospitals can be credentialed with insurers. Individual physicians can too. Robust practices get credentialed on both levels. This post will explain how medical credentialing works in both situations.

What is Medical Credentialing?

Credentialing is the process of being formally recognized by medical insurers – public and private. In order to be in an insurer’s network, and grant ‘in-network’ rates to its members, a practice must be credentialed by the insurer. The same goes for physicians.

To clarify what medical credentialing is, let’s compare it to other adjacent terms.

Credentialing vs. Contracting

A contract between your practice and an insurance provider is just that: a binding business agreement. Before you or your practice can arrange that contract with an insurer, you need to first receive their credential.

For medical staff who are not physicians (eg. physical therapists) credentialing may not be required in order to contract. This may vary by specialization, insurance company, and state.

Credentialing vs. Privileging

Privileging is the process by which individual medical staff are authorized to perform specialized care. Gastroenterology, oncology, and pulmonary medicine are examples of specialization that require privileging.

Privileges are granted by medical practices and hospitals. A physician can practice medicine within an insurer’s network without privileging. However, if they’re interested in performing specialized procedures such as surgery, they must apply for the privilege.

The Benefits of Medical Credentialing

It’s hard for a medical practice to thrive without credentialing – credentials open many doors for medical professionals.

Expanded Patient Base

It’s one of the most basic facts of health insurance: patients with insurance are incentivized to use in-network providers. Choosing in-network often saves patients a lot of money on bills – plus, insurer directories make it easier to find an in-network provider.

The more (public and private) insurer credentials you have, the wider your prospective client base. If you avoid credentials, you’re shutting the door to a lot of potential revenue.

Streamlined Revenue Cycle

Which is easier: collecting all payment from hundreds of individual patients or from a handful of insurers? When you’re credentialed and contracted, you can collect payment steadily, efficiently, and more regularly.

Of course, you can still sometimes receive payment from insurance companies if you’re out of network. However, the process is more complicated and reimbursement is less of a guarantee. 

Moderated Legal Liabilities

The credentialing process requires a practice to account for all necessary licensing and qualifications. Individual physician credentialing includes professional references and an examination of work history.

By going through this process for medical staff, a practice is able to thoroughly examine every member. Problematic work histories come to light. Unqualified candidates are easily vetted. Weeding out underqualified staff at the outset is a way to protect yourself against malpractice down the line.

Validated Reputation

On top of safety, quality-control, and financial security, credentialing might also be considered a smart marketing move. It’s an endorsement from peers in the medical industry. When prospective patients see that long standing medical insurers trust your practice, it instills confidence in the legitimacy of your business.

How The Medical Credentialing Process Works

The basics of the process are similar for practices and physicians when applying for credentials:

  • Identify available credentials
    Find the insurers that serve your community. It might be a mix of big national brands and smaller, regional brands, as well as Medicare and Medicaid.
  • Compile necessary documentation
    Every state and insurer has slightly different requirements of documentation. The list covers everything from education basics to professional endorsements.
  • Submit application
    Applications can vary across insurers – and every single application you submit needs to be error-free. Application errors can delay the process for months.
  • Track progress for each application
    In order to ensure the process is moving forward as scheduled, you’ll need to check in regularly with each insurer about each application until everything is complete.

Documentation for Medical Credentialing

Insurers have different expectations for medical practice and individual physicians. The specifics may vary across states and insurers, but you can expect to provide some fundamental documents for each one.

Medical practice credentialing documentation

  • IRS forms (eg. W-9, CP575)
  • Business license
  • Copy of lease
  • Bank account verification

Physician credentialing documentation

  • Education
  • Certification
  • Licenses
  • Work history
  • Clinical privilege history
  • Peer references
  • Insurance claims history

Physicians and practices may also familiarize themselves with the Council for Affordable Quality Healthcare (CAQH). The CAQH is a centralized industry panel that many insurers rely on for vetting credential candidates. Part of the credential application may involve submission to the CAQH.

Credentialing Factors to Keep in Mind

There are a lot of little details that can speed up your application, or slow it down – and sometimes lead to an outright denial. The following are best practices to consider at the outset of your application process.

The process can take a while

Expect it to take at least three months – and anticipate that it could take as long as six months depending on the organizations involved and complications with any given document.

Requirements vary across location and insurers

Create unique lists for every different credential to which you’re applying.

Protocol can change

The rules and requirements that governments, companies, and industry boards set for credentialing do change from time to time. Staying up to date with these changes will ensure a speedier process and fewer headaches.

Credential delays lead to reimbursement delays

The longer it takes for your practice and staff to get credentialed, the longer you’ll endure payment processing hassles and delays.

Changes in an application require resubmission of attestation

You might not need to complete a new application but you’ll need to attest for it. It’s a small detail that, if overlooked, can slow everything down.

Tips For The Medical Credentialing Process

Your practice can set itself up for success by putting these in to practice.

Decide On A Workflow

The life of a credentialing application is mighty involved. Who will onboard new staff for credentialing? What will the most efficient sequence of events be? 

Mapping out the process for your practice ahead of time – and assigning point people for each step – will keep the process efficient, effective, and low-stress.

Establish Quality Controls

One tiny error on an application form can force you to begin the process all over again. The tiniest oversight can set your business back months in this way.

Set up systems to check every detail of every application exhaustively before submitting them to insurers. This might mean sending applications through several administrative people, or using an application platform that automatically scans for errors.

Schedule The Process Into Your Hiring Protocol

An ideal, error-free, speedy credentialing process still takes several weeks – and often several months. Factor this into your human resources plan.

Plan for new hires to start seeing patients at least two months *after* hiring, because of the credentialing process. And make the official start date dependent on credential approval.

Create A Credentialing Guide For Staff

Success in credentialing staff depends just as much on the individual applicants as much as your administrative team. Set the applicants up for success.

Provide a clear, step-by-step document that applicants can use to collect documentation and complete applications according to your exact needs.

Keep A Digital Storehouse

Multiple staff submitting applications to multiple insurers, and each one with a unique set of required documentation… it piles up quickly. And some credentials will need to be updated years down the road.

Set up a central filing system for all necessary materials. Make sure it’s accessible but secure. 

Track Every Application From Start to Finish

If there is a complication with any submitted application, you might not hear about it for weeks or months down the road. Any delay in the process is an unnecessary financial hindrance for your business.

So take the initiative to make sure that every application is moving as speedily as possible. This means checking in with insurers consistently about the status of each application until the process is complete. 

Tracking is a major part of the process – and it’s one reason why many practices use a third-party service for credential applications.

Medical Credentialing With Quatris Healthco

If you’re trying to run a robust medical business, medical credentialing is a necessary step. This is true for hospitals, small practices, and individual medical staff.  The process itself is time-intensive, detail-oriented, and varied according to location and insurer. Anyone applying for credentials must be meticulous as they assemble documentation and complete forms and minor mistakes can set the process back months and slow down revenue for your business.

At Quatris Healthco, our credentialing service helps medical practices across the country minimize mistakes and maximize their collections. Evaluating a providers qualifications and practice history enhances their reputation and credibility while protecting patients and the practice.

Is a credentialing service the right choice for you? You can explore the options with Quatris Healthco.