Practice Changes/New Providers and Credentialing
Credentialing delays can stall cash flow and disrupt patient care. From adding providers to updating locations and taxonomies, proactive follow-up is critical to avoid denials and network headaches.
Transcript:
Marc:
We regularly get questions from our doctors who are running into some credentialing problems, especially lately with Blue Cross, Blue Shield and adding providers. So they hire a new associate, they’re trying to add another doctor to their roster of providers, or they’ve got another ancillary provider in their practice that they’re attempting to add, maybe it’s a physical therapist or something else that they’re trying to add to their practice. And they’re running some challenges with that. We’re also running into some challenges every once in a while with adding a new location, or if you move and Brandy, this is most definitely more in your area of expertise. What do our doctors need to know about credentialing in order to get that right, so they don’t run into problems with those networks that they want to be a part of?
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Brandy:
Absolutely, so, the first thing I would just say, if nothing else, I would keep in mind that a proactive approach is always going to be the best one. So anytime there’s a change in your business, I’m adding a new provider, I’m adding a new location. I’m moving from point A to point B. Anytime there’s a change, one of the things that it impacts is going to be your credentialing. So you want to take that proactive approach to make sure that your new provider is starting to be enrolled and added to your existing contracts, or that your new location, address and information is being added to the existing contracts, or if you’re moving, everything is updated. Changing of a bank account is another situation where a lot of clinics find they’re not getting paid, and it’s because something changed in their banking, but it wasn’t changed in their credentialing, and suddenly they’re not getting money from the third-party payers like they’re expecting.
So anytime you have a change in your office, it affects your credentialing, you want to take that proactive approach and the necessary steps forward to do that, keeping in mind too that none of these changes are are submit them today. They’re approved, and you’re good to go tomorrow. So when you’re adding a new provider, if they’re going to be starting in 30 days or 60 days in your office, now is the time to get started with the enrollment, so they can go through the screening and then the credentialing and be in the enrollment and be added to your contract. So payers don’t let us request effective dates, and so you’re going to be at the mercy of their internal processing policies to have that provider added to your existing contract. So it makes a difference. You have to, you know, almost play chess, in a way, I guess, with making sure that those providers are properly integrated. So being proactive and strategic is going to help you to do that and make sure that you’re not creating billing issues, creating patient flow or patient communications issues, and things along those lines. So some of it, anytime there’s a change in your practice, it likely impacts your credentialing, be proactive and take essential steps forward to resolve that. And certainly, Rapid Credentialing can help to do that.
Marc:
Yeah, so I think that’s a really, really good point, that they have to be proactive. You can’t just sit back. And one of the things that we run into, and I hear a lot from our doctors, too, that are going through this process, is, hey, they had requested additional information. I never knew that, and it’s because they’re not following up well. They’re not checking the credentialing status through whatever, whatever system that they have to utilize in this area. So you want to stay on top of each one of the systems and all of the information like that as well. And like Brandy said, when you run into those roadblocks, and you feel like you don’t have anywhere else to go, and you still can’t figure it out, then you want to get professional help, because worst thing you want to do is sit where you’re stuck, where your patients believe that you’re in network, or you’ve made a choice to be in network, and you’re you’re running into credentialing issues, and it’s in those cases you really do want to hire professional help to make sure it gets right. It’s a whole lot less expensive to hire the professionals than it is to sit there dormant, where you’re not getting the money you want to get paid for the services you’re really providing the patients when you’re helping bring your patients back to health in this area. I mean, what else do we run into? So really, we’re talking about adding a provider, changing, or adding a location, moving. What other scenarios do you think come into play when they’re begin to shift and adjust their credentialing?
Brandy:
Sometimes, if they get new DBAs, there’s a lot of clinics, clinics that have a new DBA, or they decide that they’re integrating, so they create a new entity. Or there’s something with their entity that changes, which, if they’re integrating, that changes your chiropractic taxonomy to being a multi-special taxonomy that affects your existing enrollments, too. So you just have to think about all of the different moving parts, that it’s the things that we don’t see that have the impact on our billing, our collections, and all of those types of things. And so into your very point that it can take a long time. Credentialing and enrollment also isn’t one of those things where you can submit it and forget about it, and they’ll come back in a few months and say, Oh, here you go. Everything is good. They submit requests. If those time out, then your application enrollment gets dumped. They’re not going to chase you down. They’re not just going to hold it. They’re not just going to allow the grace to process it through. So extreme, rigorous follow-up, and really knowing how to work with individual networks does make a big difference and helps those enrollments to come through as efficiently as they possibly can.
Marc:
And you bring up a really, really good point just a minute ago, when you talked about multi discipline, you know, the switch to a multi disciplinary practice, and you hear us talk a lot about Entity Registration and making sure that you’re the legal side of your entity is set up correctly with the with the Secretary of State, with Illinois Department of Financial and Professional Regulation, and all of that is done. But here is the thing, if you don’t jump through that hoop in regards to your credentialing, with something as simple as your taxonomy, you can have everything set up correctly with Secretary of State and IDF PR, and if you’re if you’re on your credentialing side, if your taxonomy is wrong, and all of a sudden, now you’re billing for services that wouldn’t typically be billed for by a chiropractic physician, it can actually result in denied claims. And these are things you have to stay on top of. You want to make sure that, if you’re going through a shift, that you make sure you’re covering all of your bases across the board, that you have the right style of entity, that it’s set up right with the Secretary of State, that IDFPR, that has been registered through IDFPR, and that your taxonomy is set, and if you’re changing the name, when you go through that process, that your name change is also set with all of your different PPOs. And make sure that your credentialing is spot on, and all of that is super critical. What else do you have? Anything else do you want to add in this area? Brandy, did we cover it all?
Brandy:
I think we covered an awful lot in a short time on that. Yeah. So just, you know, be proactive. Ask questions, certainly, like you mentioned before, if it’s something they like to try to do on their own, it’s certainly possible. But at the same time, the vast majority of the clinics that do reach out for credentialing help are those that tried it on their own, somehow landed in the weeds or didn’t get the outcome that they wanted. And then there’s more time and more money that’s passed already. So, you know, just keep those kinds of things in mind. But really, you know, paying attention to any change in your office and making sure that you don’t overlook those little things that can be disruptive to your cash flow, because everything also has an impact on our patient relationships, right? Not just the cash flow and the collections and the billing, but what we’re communicating with the patients, what we’re collecting from the patients, all of those different types of things, so they’re a downstream recipient of what we do or don’t do upstream in our office.
Marc:
Yeah, that’s, that’s, that’s super important, too, Brandy, thanks for joining us. And as a reminder, Brandy is the COO of Practisync in the building operations and handles that whole team that does phenomenal work. Practisync is a wholly owned subsidiary of the Illinois Chiropractic Society, and Illinois Chiropractic Society members get a substantial discount. Also, a reminder, if you’re going through the credentialing process and you’re running into some questions that you may have early on. Jump out, you can ask Paxson, make sure you use the Paxson AI, which is our trained AI, that may be able to answer some of the questions. Paxson isn’t going to do it for you. That’s why you hire professionals, but it can potentially answer some of your questions early on, especially about where to go, what to do and how you need to go about doing some of these things, so you could check that out as well, but hopefully all of this information helps you out. Brandy, thanks for joining us for this series. It’s been fantastic. Truly appreciate you. Thanks.
