credentialing for pain practice

[galenao]

Hi All

I am 6 months into completing pain fellowship. Hope to start pain practice on completion. Is it worth paying 3rd party $2500 for credentialling. I don't know much about the process and hear Trailblazer takes up to a year in texas to process medicare number. Takes longer if paperwork is done incorrectly. Money is tight

Galenao

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[mille125]

Hi All

I am 6 months into completing pain fellowship. Hope to start pain practice on completion. Is it worth paying 3rd party $2500 for credentialling. I don't know much about the process and hear Trailblazer takes up to a year in texas to process medicare number. Takes longer if paperwork is done incorrectly. Money is tight

Galenao

this is a tough one with pros and cons

PROS:

1) Your credentialing company may know certain people at the respective insurance companies who could speed up your application. I used a company and I did get on faster with a few insurers. They can also sometimes negotiate better contracted rates for you using the same principles. They will not be able to move along medicare. However, keep in mind that you can bill medicare and medicaid retroactively (you start getting paid once you are fully on medicare's panel). Therefore, I would not turn these patients away.

2) They will save you an enormous amount of time. These applications are truly massive. You likely have a lot of other things to do besides this in your fellowship. They will usually fill out your hospital credentialing forms as well.


CON:

1) Money: You are paying someone a lot of money for something that you could do yourself. If money is truly tight, you might want to do this yourself. You can also ask for a discounted rate.



Other important points/questions:

1) Is the $2500 a one time fee? If so, how long do they perform your credentialing? You will find that even though most of the credentialing is done upfront when starting your practice, you will still have some other forms to fill out later. Many credentialing companies charge a fee up front and then a monthly fee later. If $2500 covers a whole year of credentialing, I would say that it is a fairly competitive price.

2) Keep in mind that credentialing is a stepwise process. Step 1 is to get your license. Step 2 is to get your malpractice. Until you complete steps one and two no insurance company or hospital will even start to look at your application. This is important to remember. Also you cannot start step 2 until you complete step 1. Therefore, all of your effort should be towards getting your license. You mentioned Texas earlier. If you are planning to practice in Texas, be aware that the license process is quite arduous. allow 6-8 months if you dont have one.



Good luck..

 

[Tenesma]

i wouldn't pay it

1) you can see medicare and bill retro-actively up to 18 month lag

2) in some states you CANNOT see medicaid without having a medicare number - and you would be screwed retro-actively

3) when you first start out you are going to have a lot of down-time, so you could easily be doing your own credentialing - it isn't all that hard - I just made a folder with all the usual required info and made tons of photocopies ahead of time (ie: i had like 15 copies of each medical license etc...) - plus you should try to do everything through CAQH (a free website) that a lot of the insurers rely on

4) don't be fooled into thinking that credentialers will get better contracts for you - they may say that, but the insurance companies aren't idiots and as a single new provider they will hand you the crappiest contract out there, and you may not have much lee-way...

5) Texas Trailblazer takes about 5-7 months on average...

 

[Doctodd]

seems like a good price......i remember i was quoted $4500 while back. But my staff had already picked all "the low-lying fruit". It ended up being that they wouldnt have helped me get on any new contracts anyway. And i wouldnt take medicaid....unless you are completely desperate.

Another strategy is to do inpatient work without being on any plans. All docs are authorized to get paid under the hospital's authorization. You will get paid fee for service, and for some plans, this will be quite high. Then when you apply they might see it as cost effective to get you on a contract. You will at least have some leverage.

 

[galenao]

I appreciate all the response from my previous question. I have another option now. A doctor-owned billing company is offering a la carte services for practice management to include everything from credentialing, accounting, billing, etc. For a la carte the charge is 10- 15% of collections with a minimum fee until practice is busy. Minimum fee will be priced taking into account its a new practice. I am tempted mostly because the owner is a prominent neuro-surgeon in the area and I would like to develop a professional relationship with him for refferals and recommendations to colleagues. Also he may be able to help introduce me into the medical community. What do you all think of the 10- 15%. For billing alone the fee would be 6-8% of collections.

Galenao

 

[Tenesma]

that's like a management fee - and while i can see the benefit of being affiliated with a neurosurgeon there are some risks here... initially he would shunt business your way because he then gets a cut...

however, what happens if you want to terminate the business relationship - that could be a big hit as far as his referrals are concerned...

 

[Doctodd]

When you sleep with dogs you are bound to get fleas. Id be patient, let the practice grow naturally, and find a way out of that one without offending him. It just sounds like another way to be his slave.

T

 

[mille125]

I appreciate all the response from my previous question. I have another option now. A doctor-owned billing company is offering a la carte services for practice management to include everything from credentialing, accounting, billing, etc. For a la carte the charge is 10- 15% of collections with a minimum fee until practice is busy. Minimum fee will be priced taking into account its a new practice. I am tempted mostly because the owner is a prominent neuro-surgeon in the area and I would like to develop a professional relationship with him for refferals and recommendations to colleagues. Also he may be able to help introduce me into the medical community. What do you all think of the 10- 15%. For billing alone the fee would be 6-8% of collections.

Galenao

i also dont like it....

Stark??

 

[galenao]

Another alternative is become a client of his management company providing initial and ongoing credentialling at $500/month initially while practice at startup stage.

 

[member]

10-15% is high. As you grow things will change and you may plan to bring billing inhouse and then the surgeoun will stop sending youthe patinets. Better not to feed him in the beginning and dry up easy cash for him.
I did all my credentialing with Mcare. Mcaid you cnat do till you have mcare in TX . It will take you 3 hrs tops. Hire somone locally for billing and ask them They shoudl guide you. IS there an Physician alliance hwre you are at. They can make credentialing easy with pvt. insurance. whatever you do dont become neurosurgeon's slave

 

[deleted185747]

I'm thinking of starting my own practice soon. I work at 2 different offices currently and would give one of them up to start in my own part time.
1) Question is what do I need to do for credentialing? I'm already on a bunch of plans including medicare at both locations. Is there an easy way to see which insurances I'm on (Besides asking the clinic manager)
2) Once on medicare in 1 location, how do I add my own business at a new location?
3) I'm not sure if they are billing under my EIN or the groups EIN, would that make a difference?

 

[hyperalgesia]

I'm thinking of starting my own practice soon. I work at 2 different offices currently and would give one of them up to start in my own part time.
1) Question is what do I need to do for credentialing? I'm already on a bunch of plans including medicare at both locations. Is there an easy way to see which insurances I'm on (Besides asking the clinic manager)
2) Once on medicare in 1 location, how do I add my own business at a new location?
3) I'm not sure if they are billing under my EIN or the groups EIN, would that make a difference?

You are probably credentialed under your group's NPI/EIN. It's unlikely to be as easy as "adding a location" because you're talking about a new entity here. I would start by calling the biggest 1-2 payers in your area and asking how to proceed (and if they have a record of you). I could be wrong.

 

[Disciple]

Medicare credentialing needs to be done again for your new practice, though it can be done online with some data pulled forward.

Use CAQH for insurance credentialing, though you need to contact each insurer to see if there are additional forms. Shouldn't be too difficult with the insurance consolidation that is occurring.

Go through your local IPA for the HMO contracts and some of the PPO contracts as well. Otherwise, you may be getting Medicare rates or lower for your private insurance.

Work comp is a complete hassle and may require an additional staff member to handle all the work of credentialing for the various carriers, third-party administrators and self-insureds.

 

[Aether2000]

Credentialing is not a difficult task, but is a protracted task due to the lack of a unified system for doing so. We are involved with over 300 insurance plans and did it ourself, including Medicare. Keys: designate one person to do these tasks (it doesn't have to be their only job), have the staff get the contact phone number for each insurer's credentialing including Medicare, use electronic filing as much as possible, use CAQH with the knowledge that many insurers want additional forms filled out, work the credentialing every day, obtain all the necessary documents (residency certificate, medical license, DEA registration, etc) in electronic storage in one location for easy access.

 

[bronchospasm]

Use a credentialing company. Not worth the headache. I used a company called Health buisness navigators. Charged $2000 for credentialing with 10 companies. Takes 90 days once you get all info to them.
Got credentialed on time. One less thing to worry about.

When you start your practice there are some critical road blocks. Credentialing is one of them.

 

[Ducttape]

Wow..

I dont pay CAQH anything, filed everything myself (yes as Hospital employee - dont feel comfortable allowing anyone my personal data), and once in, i get a rare email or letter from them or from insurers stating some paperwork needs to be updated....

My only issue with CAQH is that i go in so infrequently (once a quarter) that i forget my password...

If you are using CAQH, your local insurers probably accept and want to use it... Might save some $....

 

[lonelobo]

If there is a local IPA, one of their jobs should be to credential you

 

[Ducttape]

there are quite a few local IPAs around me. honestly, i am more of a stout or brown ale drinker, though.

doh!

 

[Bucknut]

Bronchospasm, How was contracting with each insurance plan handled?

 

[hyperalgesia]

Once you have a digital copy of EVERYTHING: diplomas, certificates, licenses, etc, you just need to print multiple copies of each and have them at the ready. Then it's just a matter of forms. You're gonna need to give everything to an agency anyway so really, they're just filling out forms for you. I did it myself, not to save the money, but I just don't trust them to do it IN TIME. Every time I trust another person to do something I can do I regret it. Like, WTF is taking you so long?

 

[painfan]

Sorry if this has been answered somewhere else

I am working at a practice currently ( owned by another dr)
I am convinced that I want to go out on my own.
Is it possible to get credentialed by carriers ( under my new practice name, numbers etc), while I continue to work at the current practice.

Regards and thanks in advance

 

[bedrock]

Sorry if this has been answered somewhere else

I am working at a practice currently ( owned by another dr)
I am convinced that I want to go out on my own.
Is it possible to get credentialed by carriers ( under my new practice name, numbers etc), while I continue to work at the current practice.

Regards and thanks in advance

Even with a new name, it just take one phone call from an insurance company (that is confused) and your cover is blown. If you're a week away from leaving, no big deal, but 4 months away, that might hurt you.

 

[hyperalgesia]

Sorry if this has been answered somewhere else

I am working at a practice currently ( owned by another dr)
I am convinced that I want to go out on my own.
Is it possible to get credentialed by carriers ( under my new practice name, numbers etc), while I continue to work at the current practice.

Regards and thanks in advance

I don't see why not. It would be like working part time at two separate groups. There doesn't have to be any impropriety here and I think it's wise to do this. You might find that important insurance panels are closed to new docs and this might alter your plans.