Learn Effective ways to surpass Patient Restrictions and Staff troubles at your Clinic

Like every one another blog, to get started with, it has to talk about your pain points. There are pain points which every practice administrator faces, and they always wish that these could have been solved earlier. Through this, they expect that the situation could have been better and improved.

There are a few points that they could have known it earlier which in turn, would make their struggle with insurance way more easier than now it appears to be.

Every employee at your practice will be assigned for a specific task on their table. But, the issue arises when we come across a lot of naysayers and people who say it’s not part of their job description.
Staffs fear their growth in this industry. They get worried that they are not being effectively engaged to develop their potential.
Everyone, be it a physician or any other medical staff, they demand time off their work. When their hours are covered by another staff, lot of workload and pressure is involved for the latter. Literally, you will start seeing many patients leaving your office with dissatisfaction and complaining that they are not receiving enough attention.
It is tough to find people who are highly skilled enough to help you meet patient care. Recruiting physicians and their respective medical staffs have become a major issue in small and medium level practices.
One after another these issues end up with losing patients that arrive at your office.

As the administrator of your practice, when you think of the insurance, there comes the concept of enrolling your physician and your practice into an insurance panel. The enrollment process is nothing but applying you to become their participating provider into their network panel. It has two steps down the process: One is Credentialing and the other is Contracting.

In credentialing, it involves the verification of your credentials and its supporting documentation. Here the specialist at their network panel will confirm whether your credentials are obliging with the provisions and standards of the insurance panel or not. Once it is approved, they will send a contractual agreement to the physician. In this case, the physician should agree with the standard fee schedule or the reimbursement rates that suit them. In some cases, you can also negotiate these terms with the insurance and try demand for reimbursement rates which is better than the standard rates. When everything gets settled, your signed agreement will be sent back to the network panel. After a waiting period, you will be given the effective date along with insurance provider id. Credentialing and Provider enrollment are often colloquially used by everyone.

Once a physician is recruited, they must be credentialed in few of the insurances on their County otherwise, it may result in

An increased chance of denials on the basis of out-of-network as well as prior authorization
There will always be a delay in Cash flow
There will be a lot of patients restrictions, and causing toils mainly in scheduling the appointments
Even for clean claims, there will be a need for them to get engaged with the payers relentlessly.

Solution

Every staff has to be cross-trained on multiple aspects of your office. It cannot prevent staff burnout situation, but it will help your staff take care of the works that are aside from their job description.
When you are training your staff to learn multiple departments of the clinic. They eventually are propagating well over their potential. These small learning programs do not only help them develop their potential, saves yours from over-recruiting staffs.
As we know, everyone needs time off. So planning your staff holiday can create a hectic situation for other staffs who have to work at the office. These can be solved by recruiting temps or virtual vendors who can take care of these tiring front office, as well as back-office, works so that the rest of the medical staff can focus their primary time on effective patient care. The happier the patient is, the more chances they are going to return back for a visit and even higher the possibility of referring a friend.
Staff recruitment has remained a major challenge across the nation for any office. Flexibility in office hours, time-off, better pay are a few things that these staffs stay keen on. If you have recruited a qualified staff like a physician, nurse practitioner or even a medical assistant. Next thing, you have trouble is to making them participating with the insurances that your practice see every day.

Let’s look at some of the few quick notes which may benefit every administrator at the practice who plans to recruit another physician and do his insurance credentialing.

Start with Credentials

You should always start with verifying provider information such as their Education and Employment history, Professional ids like their Board Certification Number, TAX ID, Taxonomy, their Medical license to practice in the state and NPI. And other federal registrations such as DEA and CDS. Any professional training like Internship, Residency, and Fellowship. Also, note about other Credentials to be noted such as their Practice location, Mailing Address, Professional Liability insurance for the physician and their practice and if needed, verify using some professional references as well.
Understanding the Regulations

Every state may have their own laws and so does the Insurances. Some insurances do have their own clauses in recruiting a physician in their network. Some insurance may have terms and conditions that they need only fewer physicians under their network. This will hurt every new physician’s pocket who is trying to get into their network.
CAQH and Commercial Insurances

A well crafted CAQH profile would always be a PLUS while, enrolling physician's in an insurance network. It is a more adopted program by today's commercial payers. Every provider's credentials information shall be maintained and shared with affliated payers on demand.
A Prodigal Application

In order to begin with, We have to make sure the application surpasses the process for the first time after we receive all the credentials above. There should not be any repetitions in acquiring the information from the provider; this is because this may lead to more chances of working on it all over again.
The Right Person for the Job

It is essential to employ a Credentialing specialist or a Coordinator. They should manage the process and make sure that everything is going with ease. Either in-house employee or out of the office , this helps the process to be monitored, communicated, followed-up on and ensuring everything reaches its final goal by setting appropriate reminders.

As, it is a time-consuming process and for enrolling a single physician in insurance, recruiting a coordinator in-house will not be a better idea and will impact heavily on your budget on a long run. Because employing someone in-house specifically for the job demands a hourly pay, taxes, employee benefits, 401K, paid leaves that are included as the benefits of the job description.

But, when you have employed an outside company, the perks that come with it is, that you get to utilize them on the need of the hour basis for credentialing. Whereas here, you can rely on a team of people focusing on a specific task, with uninterrupted follow-ups and monitoring along with checking its status is way more efficient. The workflow will always be streamlined; and the physician always knows where his enrollment stands.

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