Physician Enrollment & Credentialing To Authenticate Providers
by Fizza Arshad Senior Content WriterPhysician enrollment and credentialing services are highly specific and difficult to
execute. This process helps in hiring new doctors, verifying their data, their
credentials, ready to earn your trust as a reliable and trustworthy physician
or specialty-specific clinician. Some medical billing companies also provide
physician enrollment and credentialing services.
Physician enrollment and credentialing remove confusion or ambiguities in
the hiring process. This process authenticates those job seeking clinicians and
puts their name on the panel of approved doctors. It’s like an official stamp
for their hard work as a student going through challenging education stages and
becoming a professional. This procedure also gives you and your institution
maximum exposure to quality health care, invaluable treatments and gradually
moving towards building a long-term reputation as a result. Don’t you want your
organization to be the number 1 trusted facility?
Residents should Stay Calm
Students need to be aware of the process of physician enrollment and
credentialing because it will, in fact, be beneficial to them and their career.
It shouldn’t come as a surprise or something unexpected to all the residents
who want to land the perfect job.
Rejection on account of Glitches
If there are issues or discrepancies in the physician’s history or
career, you must drop that applicant and move to the next one. There is a ‘no
tolerance attitude’ when it comes to patients’ health.
Physician Enrollment as a Medicare Provider
Medicare provider enrollment application or CMS-855 is the validation
form that deals with the enrollment of suppliers and providers with Medicare.
You have to fill it on a computer but sign it manually before mailing it. The
Internet-based PECOS is a better method for a smoother enrollment process.
Medicare provider enrollment status confirms your affiliation with the
program. You can check it via the National Provider Identifier (NPI) number.
You will be able to bill Medicare for any treatments rendered. P3Care provides
this facility by checking your enrollment status on its homepage.
What is My Medicare or Medicaid Provider Number?
National Provider Identifier (NPI) or Provider Transaction Access Number
(PTAN) shows that you are an authorized Medicare provider. It is also called
the Medicare Provider Number.
Rules differ from state to state for checking Medicaid provider enrollment status. A Medicaid Provider Number (MPN) confirms you with Medicaid authorizing
you for reimbursements for the services offered to Medicaid patients.
Difference between Credentialing & Enrollment
There exists a difference between the two concepts but, both of them
significantly relate to the authenticity of a provider for their liberation and
the well-being of the institution. Their skills, licensure, training, and
expertise are accepted after they go through credentialing by the health care
facilities and insurance companies.
Sign of Relief
If you don’t want to face regret or false accusations for a treatment,
you must demonstrate or run a physician credentialing process. To safeguard
your reputation as a doctor and most of all keep the patients’ safe from
unprofessional and non-verified practitioners.
Define Credentialing
Physician credentialing is a screening process. The process involves
all the background checks such as degree verification, licensure, and training
years showing your integrity and eventually confirming your place in a
healthcare facility. It is a vital part of the hiring process.
Insurance companies, on the other hand, use credentialing to ensure
providers’ addition to the network so they can bill them and reap
reimbursements promptly.
Steps Involved in Transparent Credentialing
Following are the crucial steps in the verification of healthcare
practitioners giving them the green signal.
• If you are looking for
clinicians to work in your facility, you can ask them politely if they would be
interested in getting hired and consequently credentialed.
• On an agreement, ask for
relevant information and form filling and returning it.
• Be very specific asking for
documents like educational details, work experience letters, licenses,
certifications and malpractice suits if any. Make sure the provider submits the
required data on time.
• Ask for reference letters from
at least three different sources having the same credentials as the provider.
They must not be their family or colleagues working in the same practice like
them.
• CAQH can assist you in
filtering through the information and analyzing it for correctness. For
instance, you can check their education history, employment statuses, licenses,
etc. via CAQH.
• Calling the references for
confirmation of information provided in those reference letters.
• Verify privileges by
contacting the hospitals regarding their specialties.
• It is advised not to miss any
data because it might lead to severe outcomes in the future.
Outsourcing the Task
It can save you the burden of using Health Information Technology
software, letting you focus on patient care, doing your primary duty
diligently. Physician credentialing is cumbersome and requires steps that can
get overwhelming and frustrating for the provider at times. Hence, if you are a
hospital, healthcare facility, small practice or an individual provider, do
give P3Care a call and let us explain the process to you. We are keen on taking
your calls to assist you at 909-245-8350. We do not let a single moment pass by
that could add to your financial, emotional and reputational health.
Not only you’ll be safe from malpractice suits, but your patients will
put their trust in you when you are credentialed. It makes you ethically or
morally free from any liabilities.
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Created on Apr 23rd 2018 07:41. Viewed 1,034 times.