Understanding the Differences Between Credentialing and Contracting

If you are starting up your own medical facility, or you have had a conflict recently arise with an insurance provider, it is important to know that you need to meet all the requirements before you can give care to patients in a legal and professional manner. In order to be 100 percent in tandem with any and all insurance companies, every medical practice owner needs to understand the concepts of contracting and credentialing.

Contracting and credentialing can at times be mistakenly used interchangeably, but we are here to show you how different the two processes actually are. In fact, medical billing companies near me work to help medical practices with both processes, so even if you aren’t considering billing and credentialing services yet, you should really think about it, as they can save you time, money and stress.

Credentialing

To summarize credentialing, credentialing is the organization and verification of your professional records. These records can include your college degree, professional license, certifications, references, attestations, and much more. Credentialing is meant to confirm your information that you present in your documents.

This can be easier said than done, however, as you will need to gather all the required documentation and paperwork. You will also need to present your information about any liability claims with the United States Department of Health and Human Services.

Credentialing is used by insurance providers to make sure that you and other physicians in your practice are legitimate and are in good standing. Medical facilities have a number of different insurance providers that they work with so that each patient who may be insured with one of those companies gets their payment made as quickly as possible. The number of available insurance companies varies by state, so speak with medical credentialing services to get approved faster by each insurance company.

Contracting

Contracting, as you can tell, is different from credentialing. It is the application for obtaining a partnership with an insurance plan. Of course, you cannot just file a new claim for a new insurance company and expect them to have it processed.

If you look for medical billing companies near me, you can be sure that they will update all your information for you so that you don’t forget to at the most important of times. If changes are made to your information, such as you move to a new address or change your specialization, insurance providers will not accept any new claims until you get your new information sorted out and confirmed with them. The more time that goes by without being verified, the more money you lose. As you may be aware, you need to consistently file claims to make your money, and any periods of not getting paid can result in detriments to your practice and your patients.

Conclusion

Your practice needs to have a thorough understanding of the regulations involved, so to make things easier for you, you should hire medical credentialing services and eliminate all the pressure that you and your facility faces with each insurance provider. It’s important to know that despite what you need to do to stay on good terms with insurance companies, it does not have to be hard.

A professional and medical billing service can handle contracting, credentialing and more. With a billing service, you can leave the hard work to the professionals while you and your staff focus more on what you need to do in the office. If a hired hand just isn’t working out in filing your claims, consider a professional billing service for just a fraction of the cost.

For wonderful medical coding services in Texas, the author of this article suggests Right Medical Billing.