Are you maintaining the Credentialing and Enrollment Status?
A proactive Practice Manager ensures thorough Credentialing and Enrollment at the Medical Practice. This strengthens patient’s confidence in the patient care services offered.
Now, as the days go by, the daily routine at the Medical Practice gets hectic. Practitioners are consumed with their patients and the staff is busy providing support services as well as taking care of the administrative tasks. The practice manager remains satisfied as all the practitioners are credible and successfully maintaining the patient care status. In all this, there is a high chance that the manager loses the track of time by which the credentialing status of the practitioners is required to be reinstated.
Source: https://www.mgma.com/data/data-stories/more-than-half-of-practices-report-credentialing-r
Problems with an expired Credentialing status
Lost Revenue: Without updated credentialing, the provider faces deactivation by the payer. This could result in major revenue losses, as the claims for such providers are denied. Re-credentialing can take 180+ days, so proactive planning is vital.
Loss of Privileges: Expired credentialing can result in loss of hospital privileges. Providers need hospital privileges to join/remain compliant with health plans.
Liability Concerns: Practicing without a valid license risks lawsuits for the provider & employer.
Fines and/or Sanctions: Expired credentials risk fines & sanctions for provider and facility. Additionally, the provider’s malpractice insurance rates may increase after receiving a sanction.
Refusal of Future Contracts by Payers: Legal issues &expired insurance risk payer rejection for providers.
Low Patient Retention: Inactive providers lose patients if out-of-network & unable to provide care.
Additional Work: Reactivating providers costs practices time and resources.
How can expiration of Credentialing and Enrollment status be prevented?
Tracking provider credentials is time-consuming and complicated. Hiring a credentialing service helps maintain provider status.
A few tips for maintaining the Credentialing and Enrollment Status:
Centralize the Credentialing process
Proactive Monitoring and Planning
Proactive credentialing when adding new practitioners.
Proactive Recertification and Recredentialing Status Update
At AltuMED, our credentialing maintenance and monitoring services include:
- Report expiring provider documents in advance.
- Quarterly CAQH attestations and document uploads.
- Re-credentialing and re-validation for payers.
- Demographic updates, such as address/phone/name change.
- Medicare requests provider demographic updates every 6-12 months.
- Tracking malpractice insurance, CE credits, and practice services.
We audit provider participation and rosters for facilities. Annual health plan audits are crucial for practice protection legally and financially. Contact us to learn more about our credentialing and enrollment service.
Practice Credentialing and Enrollment Status Template
Payment issues arise due to decentralized credentialing and enrollment in practices. This template provides a strong start for your practice to prevent such issues. The template has two main tabs: Facility details & credentials, with a credentialing checklist. The payers tab stores payer details for Michigan; editable for customization.
Contact us for template questions or credentialing/enrollment services.
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