What is medical Credentialing?
Medical credentialing is the process of getting a license to practice healthcare services after document verification. Credentialing verifies the qualifications of the healthcare provider. The provider is either a doctor or a medical facility. It is the primary step before privileging any doctor or a medical facility with the license to practice medicine. The insurance company mandates this process. The verification process includes cross-examination of the provider’s educational qualification, experience, training, skills, license, insurance, and criminal background (if any). It also cross-examines the healthcare providers’ credentials for accuracy and authentication. Medical credentialing further leads to granting consulting privileges or admitting privileges and/or surgical privileges to the hospital/healthcare provider.

Why is Medical Credentialing Important?

The medical credentialing process is time-consuming. But it is a prerequisite to establishing trusted healthcare services. Credentialing is important. Credentialing:

  • Enhances patient safety and security
  • Allows healthcare organizations or doctors to employ authentic and experienced medical staff
  • Prevents healthcare organizations from losing revenue due to incompetent or unqualified medical practitioners
  • Improves business of the healthcare facility with competent practitioners on the payroll
  • Prevents charges of potential lawsuits due to compliance violation in medical practice

Statim LLC medical billing will take utmost care in end-to-end credentialing by verifying the various documents. The documents include:

  • Medical license
  • Board qualification/certification status
  • Updated curriculum vitae
  • Residency diploma
  • School diploma
  • Professional reference(s)
  • ACLS/BLS certification
  • DEA certificate
  • Driver’s license
  • Social Security card

Electronic credentialing and cloud software can help enhance the process of credentialing further. Statim LLC employs the most updated technology in medical credentialing and ensures an easy credentialing process.

What is Medical Contracting?

Medical Contracting is the official agreement between a healthcare provider and a payor. The healthcare provider can either be a doctor or a medical facility with a fleet of medical staff. The payor is either an insurance company or the individual seeking services or in certain cases, both). Contracting is a crucial step in billing and coding services.

Why is it crucial in medical billing?

Contracting is crucial in medical billing because:

  • Ensures easy claim-submission, maximum revenue recovery
  • Outlines the charges for billed medical services
  • Determines the time frame for submitting and reimbursing claims
  • Determines the eligibility, scope, and limit of the insurance covered by the payor for the varied health care services
  • Outlines the method for claims reimbursement on denial of claims
  • Outlines the rules for terminating the contract

Most often, healthcare professionals begin offering their services without clearly understanding the insurance eligibility, patient data verification, and other rules laid down in the provider contract. Especially, a healthcare facility can incur heavy losses if the contract includes a unilateral agreement. This agreement allows the payor to alter the terms of the contract without the consent of the healthcare provider. Therefore, to avoid such losses and ensure maximum revenue recovery, it is important that the health care provider closely reads the provider contract. Statim LLC Medical Billing has experts who can closely read the provider contracts and assure maximum revenue recovery.

What is the Difference Between Credentialing and Contracting?

  • Credentialing is a process that authenticates the qualification of the healthcare provider. Contracting is a legal agreement between two parties (healthcare provider and payor) to ensure clean claims and maximum revenue recovery.
  • Credentialing generally precedes contracting and is a prerequisite to establishing a trusted healthcare service. The credentialing process majorly involves receiving a license after certificate and document verification by the concerned authorities to provide healthcare services to clients. Contracting follows credentialing. It includes the payor too.
  • Credentialing plays a vital role in providing services (surgical, consulting, or admitting) to the patients. Contracting plays a crucial role in ensuring revenue recovery after healthcare services.

Boosting your Credentialing and Contracting Process.

Credentialing and contracting processes can be cumbersome if you choose to do it yourself. Instead, hiring an expert team can boost your credentialing and contracting processes, and help you focus on your healthcare services exclusively. Let the experts handle this time taking task. Hire Statim LLC billing and coding services for end-to-end credentialing and contracting services. Our expert team is skilled at close reading provider contracts, verifying your medical staff’s credentials, getting the necessary licenses for your healthcare facility to ensure trusted healthcare services.

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