Credentialing, also known as provider enrollment, is often a mysterious subject for rehab therapy providers. Throughout your career as a provider, you’ve probably heard a bunch of credentialing myths that you may have taken as truth. Let’s explore some of the common misconceptions about credentialing and clarify them so this topic can be less daunting.
1. “I can transfer my company's existing contract to my new business.”
Some rehab therapy providers believe that if they create a new company with an entirely new tax-ID, they can simply add that company to their existing insurance contracts. This is a myth. Each insurance contract is specific to the tax-ID of the practice. If your new business has a different tax ID, you will need to obtain new contracts with each insurance company for the new tax ID.
2. “Part-time therapists don’t need to be credentialed.”
If you want to ensure your billing is compliant, all therapists, even part-time providers, need to be individually credentialed with your practice’s insurance carriers. Co-signing notes for part-time providers is not an acceptable workaround for all insurance companies. Reference your insurance contract for policies such as requiring that the credentialing process be started for a provider before allowing co-signing of notes by an in-network provider. Some insurance companies may not even require individual provider enrollment which is why it’s important to call the insurance company and ask.
3. “There is no way to get around a closed panel.”
Finding out that an insurance panel is closed can be frustrating for a new business owner, especially if it’s an insurance that a large portion of your area’s demographic use. But there are ways to overcome a closed panel notice. For example, you could submit an appeal letter, highlighting what separates your practice from others in the area. Another option is joining an Independent Physicians Association (IPA). These companies charge an annual membership fee and by paying that fee, you are added to their existing contract with the closed-panel insurance company.
These credentialing myths have existed for years but with the help of experts, like the people at Account Matters Inc., we can help you get your start-up practice in-network or assist in getting a new provider enrolled faster. For more information about our credentialing services, give us a call at 508-422-0233 or send us an email at email@example.com