Helping Medical Practices Increase Revenue

The Provider Credentialing Process Explained

Credentialing a new provider to validate his or her qualifications, work history, board certifications and references is critical for all healthcare organizations as well as smaller practices.

 Normally, there are two separate processes to credentialing:

• Privileging approves a provider for performing a specific set of privileges or perform certain specific procedures.
   
• Provider enrollment is inclusion of a new provider in all of an organization’s insurance plans, ensuring that correct and full payment is received for their services.

With 2018 in the record book, it's time for physicians to start looking ahead to 2019. Changes to the ways in which payers reimburse physicians for services, competition from new providers, and changes to healthcare law will all play a major role in how medical practices run their business. As the year progresses, medical practices should keep the following trends in mind so that they're prepared for the road ahead.

 Although there have been many discussions about changes to CMS codes and changes to E&M coding for 2019, some of the big changes coming to telemedicine have slipped under the radar. With changes to the 2019 Physician Fee Schedule and new legislation passed in 2018, there are a number of different changes your practice will need to know in the coming year. Here’s a closer look at some of the significant changes in telehealth for 2019 that may actually help your practice boost your bottom line.  

Highlights of 2018 Reviewed

2018 has been quite a year within the healthcare industry for patients, providers and especially medical claims billing. Knowing what to expect can help you to improve and strengthen your own medical billing strategies in 2019 and beyond. Over the past year, we’ve seen new trends and changes in the following areas:

Failing to obtain prior authorization before the service is performed can result in a claim denial. In most cases, services requiring authorization before service include high-cost ancillary services, surgical procedures, or services that may be considered unnecessary in certain circumstances.