insurance panel credentialing

[CAP1228]

Hi everyone,

I was talking with a colleague recently who recommended I start applying for insurance panels as early as I can, because it's often a long and tedious process. I have the time at this point (have applied for child match and am waiting for results), and would like to begin the process.

I know that when I graduate from fellowship, I want to do at least part time private practice and will start by taking insurance. I just had a few questions about this process and would very much appreciate any feedback/insight/advice from you all. Of course, I'm cold calling insurance panels too, but was hoping for a more unbiased perspective.

1. If I register to be on a panel, can I opt out of the panel at a later date (for whatever reason, let's say b/c I find they're poor at reimbursement or I want to transition to cash only practice?

2. Does one have to negotiate reimbursement rates early in the process? Can I apply to be on a panel now and negotiate reimbursement at a later date? Obviously, I will have nothing to negotiate with for a while, my purpose at this point is to just to have all the credentialing done so there's no major hold up in starting a practice when I've completed fellowship.

3. If I decide to join a group, will having credentialed in the past (at this time) make things messy?

4. Are there any insurance panels that are particularly good or bad (for reimbursement or otherwise)? If so, which?

5. Anything else I should be thinking about before starting this endeavor, that I may not be aware of?

Thanks again so much--hope you're all beginning to enjoy a great holiday season!

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[PistolPete]

Questions I'm interested in too! Sorry, don't have the answers so will be following this thread with you…

 

[Shikima]

Word of advice, let the hospital/clinic/health center do the credentialing for you. The process is long, tedious and full of horrible paperwork that you likely won't understand and require to show affiliation with a hospital of some sort. It doesn't take all that long in reality and won't prevent you from getting paid as a W2 wage earner. The difficulty will be if you're going into private practice and you'll need a good 9-10 months before you see earnings rolling in regularly from insurers and such.

 

[milesed]

We use CAQH and our billing staff redo it every year. CAQH sends out info to a ton of specific insurance panels for us.

 

[hamstergang]

I have the time at this point (have applied for child match and am waiting for results), and would like to begin the process.

I know nothing about this topic, but starting the process 2 years before you need it sounds crazy to me.

 

[smalltownpsych]

I know nothing about this topic, but starting the process 2 years before you need it sounds crazy to me.

I have just gone through the process for the second time and the employers did it for me. I don't even think that you would be able to do it now since they will want current info and qualifications. Also, some insurance panels were within 30 days and some took up to 90 and that was worse case scenario because my current employer has some pretty poor adminstrative staff in charge of the process. At the CMH where my wife was the one in charge of the process, it took from 2 to 6 weeks to get all paperwork done. Each state and insurer will vary a bit but I don't think it will take that long.

 

[Indodo]

1. If I register to be on a panel, can I opt out of the panel at a later date (for whatever reason, let's say b/c I find they're poor at reimbursement or I want to transition to cash only practice?
Yes you can opt out. They may try to make this difficult for you and try to keep you in the system but you can do it.

2. Does one have to negotiate reimbursement rates early in the process? Can I apply to be on a panel now and negotiate reimbursement at a later date? Obviously, I will have nothing to negotiate with for a while, my purpose at this point is to just to have all the credentialing done so there's no major hold up in starting a practice when I've completed fellowship.
You probably cannot negotiate as a solo provider. Groups, particularly large groups, have the luxury of market share. Caveat to this is if no other CAPs are on the panel in your area.

3. If I decide to join a group, will having credentialed in the past (at this time) make things messy?
No this will make it easier. Usually.

4. Are there any insurance panels that are particularly good or bad (for reimbursement or otherwise)? If so, which?
Depends on where you are geographically. Anthem may be good in one location, terrible in another.

5. Anything else I should be thinking about before starting this endeavor, that I may not be aware of?
Billing codes and how to document. Where you want to practice. EMRs. Most of all, learn to be an excellent physician (although you are probably aware of that).

BTW, other physician associations do a much better job at helping their members out with this kind of thing than the APA. Which is why I am no longer a member. When I needed this kind of help, their "advice" was vague and essentially useless. The AAFP, AMA has pretty good resources as do some of the specialty associations but they are often limited to their specialty. I think this contributes to why so many psychiatrists don't take insurance.

 

[nitemagi]

Anecdote - I got credentialed once with an insurance company. It took me two years and hiring a lawyer to get off the panel. They "lost" my repeated emails and faxes and hard copy letters. I had my asst try to get through by the phone, and cumulatively spent 25+ hours trying to get through to the right person.

 

[F0nzie]

Anecdote - I got credentialed once with an insurance company. It took me two years and hiring a lawyer to get off the panel. They "lost" my repeated emails and faxes and hard copy letters. I had my asst try to get through by the phone, and cumulatively spent 25+ hours trying to get through to the right person.

Dat runaround

 

[PistolPete]

Anecdote - I got credentialed once with an insurance company. It took me two years and hiring a lawyer to get off the panel. They "lost" my repeated emails and faxes and hard copy letters. I had my asst try to get through by the phone, and cumulatively spent 25+ hours trying to get through to the right person.

Mind saying which insurance panel that was? :/

 

[fiatslug]

Anecdote - I got credentialed once with an insurance company. It took me two years and hiring a lawyer to get off the panel. They "lost" my repeated emails and faxes and hard copy letters. I had my asst try to get through by the phone, and cumulatively spent 25+ hours trying to get through to the right person.

That's horrible! Does that mean that you just get a bunch of calls from patients with that insurance and you say, no, sorry, I'm not on that panel anymore--or are you obligated to take those patients and remain on the panel??

 

[Leo Aquarius]

Anecdote - I got credentialed once with an insurance company. It took me two years and hiring a lawyer to get off the panel. They "lost" my repeated emails and faxes and hard copy letters. I had my asst try to get through by the phone, and cumulatively spent 25+ hours trying to get through to the right person.

Hey insurance panels, if you're reading this I'm glad to say this doctor will never accept insurance and encourage as many colleagues as I can to do the same. You screw doctors over by sometimes throwing our claims away, reimbursing a fraction of what we bill, and giving us more paperwork year after year.

Here's my fist, now go punch yourself.

 

[F0nzie]

I recently received a call from a prospective patient that was yelling at me on the phone wondering why I do not accept insurance. I calmly told him that he needed to call his insurance company for a list of providers. He then told me that their list is outdated and none of the psychiatrists' offices are returning calls. I acknowledged his frustration and advised him to file a complaint with his insurance company.

 

[nitemagi]

That's horrible! Does that mean that you just get a bunch of calls from patients with that insurance and you say, no, sorry, I'm not on that panel anymore--or are you obligated to take those patients and remain on the panel??

I told them I'm not accepting any more patients with that insurance.

 

[clusterF]

I told them I'm not accepting any more patients with that insurance.

So were you able to charge cash if you were still on the insurance panel but no longer accepting patients. I would imagine that would get tricky with the contract/legality etc.

 

[nitemagi]

So were you able to charge cash if you were still on the insurance panel but no longer accepting patients. I would imagine that would get tricky with the contract/legality etc.

If you mean could I charge cash for patients who had that particular insurance? No, I couldn't. Most of the time I just didn't see them, because the insurance company wasn't responding to all my letters/emails.

 

[vistaril]

Hey insurance panels, if you're reading this I'm glad to say this doctor will never accept insurance.

I can tell you right now that if you are never(that's a strong word) going to accept insurance in any practice setting you are going to be a psychiatrist who also almost never treats a lot of types of psychiatric illnesses and presentations(including a lot of the ones that separate our training from non-physicians in mental health)

I'd be interested to know, for example, how many current patients in the WHOLE COUNTRY right now on Clozaril cash pay for psychiatric services? I can guarantee its a pretty small number....and the few that do probably wont show up in your office.

Im not saying psychs shouldn't pursue their own private pay/out of network/therapy patients. But to say you are never going to accept insurance period is going to really limit what you will be exposed to post-residency.

 

[Shikima]

Hey insurance panels, if you're reading this I'm glad to say this doctor will never accept insurance and encourage as many colleagues as I can to do the same. You screw doctors over by sometimes throwing our claims away, reimbursing a fraction of what we bill, and giving us more paperwork year after year.

Here's my fist, now go punch yourself.

Private Pile, choke yourself?

 

[Indodo]

If you mean could I charge cash for patients who had that particular insurance? No, I couldn't. Most of the time I just didn't see them, because the insurance company wasn't responding to all my letters/emails.

I have patients that I am already seeing whose insurance I want to drop. Also there is the issue of abandonment. What would you do in this situation?

I have thought of a couple of things. I have already started telling many that I won't be taking their insurance so they can change during open enrollment. Outside of that, try to refer them to someone I know will take them or ultimately give them 3 names, 3 months of medications and say goodbye?

Not really happy about the last choice and I'm not sure I can do it. Which is what I think the insurance companies count on.

 

[nitemagi]

I have patients that I am already seeing whose insurance I want to drop. Also there is the issue of abandonment. What would you do in this situation?

I have thought of a couple of things. I have already started telling many that I won't be taking their insurance so they can change during open enrollment. Outside of that, try to refer them to someone I know will take them or ultimately give them 3 names, 3 months of medications and say goodbye?

Not really happy about the last choice and I'm not sure I can do it. Which is what I think the insurance companies count on.

I believe the typical practice is to give them notice that you're dropping the insurance, and the option to continue via cash. If they can't do it, give them a letter in writing with alternatives (usual termination process) -- along with adequate amount of time to see someone there -- that covers the abandonment. I also encourage ppl to check their coverage for "out of network providers" as that would help them get reimbursed somewhat for seeing me.

 

[Indodo]

But what happens if you drop the insurance but the insurance doesn't drop you.
It reminds me of the argument religious people use regarding satan. You may not believe in satan but satan believes in you.

 

[romanticscience]

I'm a PGY-3 in psychiatry and I'm considering a fellowship. As someone interested in dynamic psychiatry, I hope to have a private practice. My question is, can someone in fellowship become credentialed with insurance companies, if they get their timing right? Could I have private patients while in the fellowship?

 

[sunlioness]

I don't know the answer to that, but I don't see how you'd make enough with the limited number of patients you could see outside of your fellowship duties to pay your liability insurance premiums.


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[F0nzie]

I'm a PGY-3 in psychiatry and I'm considering a fellowship. As someone interested in dynamic psychiatry, I hope to have a private practice. My question is, can someone in fellowship become credentialed with insurance companies, if they get their timing right? Could I have private patients while in the fellowship?

This is uncommon practice for residents and fellows. Personally, I recommend focusing on improving your knowledge and skills in training. You will have the rest of your career to figure out how to deal with insurances and business.

If you really cannot wait, ask your PD, call insurance companies, and make a list of all the things you would need in order to see private patients on the side. Once you have all the facts you will probably be able to answer this question on your own.

 

[TexasPhysician]

I'm a PGY-3 in psychiatry and I'm considering a fellowship. As someone interested in dynamic psychiatry, I hope to have a private practice. My question is, can someone in fellowship become credentialed with insurance companies, if they get their timing right? Could I have private patients while in the fellowship?

Insurance companies panel you at a set location. You would need to begin renting your space months in advance to give credentialing time to process. In the meantime, you are paying rent and malpractice insurance. You would likely need to hire a front office staff as well. Is it worth it?

 

[sunlioness]

You could get away without a front office staff if you do all that yourself. I did that. You might want to hire a biller though. And bear in mind that you're on call 24/7 for these folks. A voice mail message with a Crisis number on it isn't standard of care.

Also need to be aware of the pertinent regulations about medical record. Will you have an EHR? A paper chart? How long are you required to keep the records in your locale? Where will you keep them?

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[TexasPhysician]

You could get away without a front office staff if you do all that yourself. I did that. And bear in mind that you're on call 24/7 for these folks. A voice mail message with a Crisis number on it isn't standard of care.

I'll kindly disagree with the above.

Due to being in training and call volume, hire a front office staff. The hassles of doing it yourself are not worth it. You also lose a ton of potential patients when it goes to voicemail. A good front staff will bring in many more patients than their worth.

I disagree with this standard of care. What do you realistically do as a psychiatrist with a patient that calls at 2am? If a true crisis, we can't safely handle it in an outpatient setting anyway. I would send to the ER like any voicemail would do. Without a crisis causing harm, there is no liability. If meds are accidentally lost, no pharmacist is available to fill a script outside of regular hours. Does any psychiatrist perform CBT coping skills at 2am?

I do have voicemails routed to my phone, so that I can handle things in an appropriate manner. I also provide a crisis plan at all appointments. I'd argue that a productive crisis plan in advance is a lot safer than trying to reach any psychiatrist at 2am.

 

[romanticscience]

Thanks for all your advice! I would likely be restricting my practice to psychotherapy with or without medication. I'd hope that by doing this I'd attract patients motivated enough to engage in this type of treatment (weed out med seekers) and thus have lower volume. Hopefully this would reduce time and energy devoted to administrative issues.

 

[romanticscience]

I've seen this wording posted on a colleague's website, "If using your insurance, you will be responsible for the copay or percentage not covered by your insurance." Is this balanced-billing?

 

[michaelrack]

I've seen this wording posted on a colleague's website, "If using your insurance, you will be responsible for the copay or percentage not covered by your insurance." Is this balanced-billing?

it could mean the deductible or co-insurance (which is basically like copay except % rather than $ amount)

 

[vistaril]

I'll kindly disagree with the above.

Due to being in training and call volume, hire a front office staff. The hassles of doing it yourself are not worth it. You also lose a ton of potential patients when it goes to voicemail. A good front staff will bring in many more patients than their worth.

I disagree with this standard of care. What do you realistically do as a psychiatrist with a patient that calls at 2am? If a true crisis, we can't safely handle it in an outpatient setting anyway. I would send to the ER like any voicemail would do. Without a crisis causing harm, there is no liability. If meds are accidentally lost, no pharmacist is available to fill a script outside of regular hours. Does any psychiatrist perform CBT coping skills at 2am?

I do have voicemails routed to my phone, so that I can handle things in an appropriate manner. I also provide a crisis plan at all appointments. I'd argue that a productive crisis plan in advance is a lot safer than trying to reach any psychiatrist at 2am.

it ALL depends on the setup. If you are the only psychiatrist there(unless you have a ton of psychologists and therapists sharing the expense) there is no way you can afford a whole 'front office staff'. You simply won't be generating nearly enough revenue with your codes to afford this. There are many truly solo practitioners who have no front office staff. Thats really the only way to make it work if you are going to truly work alone(or maybe hire one part time girl).

But if you have 4+ other providers equally sharing the costs with you, of course then you can afford a front office staff.

 

[OldPsychDoc]

...Thats really the only way to make it work if you are going to truly work alone(or maybe hire one part time girl). ....

Welcome to the 21st century, Dr. Draper...You may find that a few things have changed while you were in cryo.

 

[vistaril]

Welcome to the 21st century, Dr. Draper...You may find that a few things have changed while you were in cryo.

?? I don't know the exact m/f breakdown in terms of office help, but I'm pretty sure the vast majority are still female.

 

[hamstergang]

?? I don't know the exact m/f breakdown in terms of office help, but I'm pretty sure the vast majority are still female.

Because that was the point.