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Credentialing 101

Insurance credentialing can be a confusing and lengthy process that will leave you frustrated. Unfortunately, you don't get paid by third-party payers unless you are credentialed and have a contract in place. It's important to understand what credentialing is and what it is not. Credentialing is the process third-party payers use to evaluate your qualifications and your clinical history. They want to determine that you are who you say you are, that you don't have any malpractice claims against you, that you are good providers with good references, that you are not a risk to them or to their…


MPS Credentialing Allstars

Medical Practice Success understands the frustrating but necessary process of credentialing and health insurance enrollment required of healthcare providers when running a practice or setting up a new practice. While you could process your own paperwork or try to hire a staffer who is familiar with health insurance enrollment and credentialing, save yourself time, money, and headaches by partnering with our organization. Our Provider Enrollment specialists become part of your staff, your own in-house credentialing department, enabling you to focus on your patients rather than worrying about…


Flu Season is Here - Are YOU Ready?

To have a successful flu season with the highest level of reimbursement, there are a few steps that you should take. The new flu injection CPT codes and payment allowable goes into effect each year on Aug. 1 for Medicare and most governmental payors. This allows vaccination efforts to begin as soon as the seasonal influenza vaccines are available. Just like any other injection, you will need to know the following NDC information to determine the correct CPT Vaccine Code to submit on your claim. • What brand will you be using for this season. • Whether the product was trivalent or…


Is Your Front Desk Lending YOUR Money?

Patient payments are a vital part of revenue cycle management, however, when patients fail to take financial responsibility, many providers and their practices take a hard hit. Not only do statistics show that 81% of self-pay net revenues will go unrecovered but that the default rate for self-pay patients is at a rate of 30% or higher depending on the market area. This means that it can cost twice as much to collect from a patient than it does from a payer. One reason self-pay revenue goes unrecovered commonly is that the patient’s benefits and/or eligibility were not verified before the…


Protecting Your Practice

You only have to go back about ten years to the “good old days” of being able to surf the internet without fear of your data being breached or corrupted in some manner as to make you take extra safeguards to protect it. Since 2010, when the first major ransomware threat was noted, we’ve steadily seen an increase of attacks on nearly every industry that regularly utilizes electronic data in their daily operations. In 2018, the rate of ransomware attacks totaled in excess of 850 million as reported by PhishMe, Inc and even more startling is the fact that 75% of the companies infected with…


Left Without Being Seen in an Urgent Care – Is this a Culture issue?

Are you experiencing a productivity barrier? Perhaps you have an EHR adoption issue and/or a fundamental EHR workflow issue? Or possibly you have problems with getting timely results from the lab or the imaging department. If any of these things sound familiar, you may have a problem with “Left Without Being Seen (LWBS)” in your organization. Maybe patients are not feeling welcomed and like they are a priority. You may be surprised to know that some of these issues can be addressed by changing your organization’s Culture. If the issue is productivity related, there is a cure for that.


Don’t Flush Those Expired Medications!

About 3% of all purchased medications expire before their use. Like most medical practices, at some point, you must manage these expired medications. Whether your practice offers sample medications, in-office prepackaged dispensing, or merely administers medication to patients as part of their treatment, it’s inevitable that some of your on-hand stock may get damaged or expire and become unsuitable for patient use. While this medication is certainly of no further value to your practice—and you don’t want to risk it remaining in inventory where it may be inadvertently administered to a…


Are You Treating Your Patients or Your Software?

The use of technology has increased rapidly within the past decade, and the delivery of urgent care medicine has adapted along with it to keep up with demands. Though, often the desire to provide competent but quick care has come at the sacrifice of providing compassionate, patient-centric care. When a practice’s mantra is focused on meeting a “door-to-door” transit time, it’s not easy to develop a lasting or meaningful relationship with the ailing or injured patients at any point of the person’s interaction with your organization. While we surely emphasize friendly customer service, it’s not…


Patient Debt: Create a Plan Your Practice Can Tolerate

It’s not a surprise to many—practice owners, patients, and providers—that the cost of healthcare has increased drastically in the past several years. While the actual rates for specific services billed might not have changed significantly, the out of pocket cost to patients (deductibles and after-insurance responsibility) has increased by over 30% since 2015. According to a Black BookTM RCM study in 2018, less than 5% of families had a deductible of $500 or less in 2015, while greater than 50% of families now have deductibles in excess of $3000-5000, and over 30% have deductibles higher than…


Clarify Incident-to Billing

If your practice is like many others you are likely staffing with a majority of mid-level providers. The reason for doing so may encompass several scenarios, such as difficulties in finding and attracting physicians to lowering staffing costs of operations. One thing is certain, electing to staff with nurse practitioners or physician assistants brings certain challenges when it comes to submitting claims for patient care. Many practices that employ mid-levels to provide patient care believe “incorrectly” that since they have a physician providing oversight AND since that same physician is…


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