All Posts in Category: Medical Billing

Physician Credentialing Services

How Much Time Are You Wasting On Physician Credentialing?

You have toiled for years to gain the right skills, knowledge, and training to become a doctor who selflessly serves their patients. Finally, you are looking forward to joining a clinic or practice. You are certain this is the start of a golden career ahead. But before you can actually start practicing medicine, you need to become a credentialed physician

Credentialing is the process of verifying your education, training, experience, and license to practice. It basically means the medical authorities authenticate you as a physician with an original and genuine educational and professional background. Though you can undertake this exercise yourself, physician credentialing services take away all the hassle from you and do the verification in an organized, professional manner. Their services are trustworthy, and important medical institutions and offices vouch for them.

The Significance of Physician Credentialing Services

Physician credentialing is important for doctors, nurses, and all healthcare providers. This physician credentialing process acknowledges and places on record the training and certification of these professionals in medicine. It also implies that your license to practice is valid, recognized, and authenticated. 

A physician credentialing service undertakes a high level of scrutiny so that no one and nothing can compromise the integrity of the medical profession. The ethical standards of people working in medicine should always match standards set by various medical authorities and institutions.

Why Outsource Physician Credentialing Services

If you undertake physician credentialing by yourself, there will be a lengthy procedure to follow. There will also be considerable paperwork to submit and numerous phone calls to make. You also need to be familiar with various rules and regulations, which vary from state to state in the USA. 

So, do you have the time and resources to undertake this by yourself? You need a minimum of 3 months to complete the credentialing. However, it might take longer than that, and there will be a lot of communication and coordination you will have to do in the interim. As a doctor who is first and foremost a caregiver, your priority would be diagnosing and treating people. This indicates that you may have to leave this task to the professional physician credentialing services. After all, just a month of time and expense diverted to activities not related to providing patient care is a considerable dent in your income. Multiply this by (at least) 3, and you know how much you are losing when you undertake physician credentialing on your own.

Relying on a Physician Credentialing Service Provider

Now, let’s consider a scenario where you have roped in a professional physician credentialing service to do this for you. You just provide them with the necessary documents and sit back and relax. Such a service usually has experts who undertake complete physician enrolment and credentialing services for you. 

How do they do that? They have worked with and are familiar with the functioning of all major commercial insurance carriers. So, no matter which insurance carrier covers your practice, the credentialing service will take care of everything for you. They are there for you right from filling the application. These services then submit the same and also continue following up with these carriers until such time that your application is approved.

Your credentials are very significant for your professional identity and future medical practice. When selecting the physician a patient would like to visit, the first thing they check is the education and years of experience a doctor has. It goes without saying that you don’t want to make any errors while undergoing credentialing – all the more reason to select an expert, trustworthy physician credentialing service that does full justice to your profile.

Why Medical Healthcare Solutions?

At Medical Healthcare Solutions, we provide a doctor credentialing service that is efficient, timely, and comprehensive. We don’t mind going the extra mile to ensure nothing is left to chance when it comes to your physician enrolment and credentialing. We hand-hold you throughout the process, leaving your time and resources for other, more important tasks. With us as your credentialing service partner, all your information and documents are in safe, expert hands.

How exactly do we undertake such an accurate physician credentialing service on a large scale? It’s simple. We have a team of experts who are well versed with the functioning of major insurance carriers and their framework of rules and regulations with respect to physician enrolment and establishing credentials. 

We are there with you from start to finish. Not only do we help you actually fill in the application, but we don’t rest until the final credentialing is done. It does not matter how often we need to initiate and follow up; what matters is the seamless process completion.

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Physician Credentialing Services

Physician Credentialing Services Can Save You a Lot of Time

The internet today is a major part of the healthcare system. A majority of patient appointments nowadays have found a place online. This also has extended to updates regarding treatment and other health-related activities. 

Before any physician can have an online profile as part of their practice, the hosting portal or platform needs to verify the genuineness of the physician. In addition, they should garner basic information like their registration number, board certifications, admission privileges, work history, etc. 

You also perform background checks to rule out any prior medical malpractice or otherwise untoward event in the doctor’s earlier period of caregiving. You can call this process of authenticating a physician’s record and ascertaining whether the practice falls under illegal or illegitimate as credentialing.

Process of Physician Credentialing Services

Physician Credentialing Services

Under this process of physician credentialing services, the entire professional life of a doctor is vouched for and ascertained to be true. For instance, it includes their degrees and board certifications, years of practice, hospitals where they help and provide care. Further, it also looks after their clinic and registration numbers, and anything else related to their work histories.

Most health maintenance organizations and online healthcare portals have a physician credentialing service in place. This process begins with the physician (or healthcare platform/portal) completing an application for charges against care provided. Later, they submit it to the insurance carriers. 

Once the carriers accept such an application, the process of credentialing is complete. Besides this, healthcare provider enrollment, or the procedure of including a doctor as a caregiver with a particular healthcare portal, also falls under physician credentialing service. 

Undertaking a physician credentialing service ensures that the doctor’s information and records are up-to-date in the insurance carrier’s accounts. Also, the insurance carriers receive intimations about the changes in hospital affiliations and practice locations as part of credentialing follow-up.

This process of physician credentialing service is really beneficial to both doctors and health maintenance organizations. Let us look at how and why.

Less Time Wasted in Undertaking Self-Credentialing by the Physician:

According to a study, physicians spend a significant amount of time in activities not related to direct caregiving and examining patients. Paperwork and other administrative tasks like scheduling eat up this time. 

When a doctor undertakes the process of credentialing themself, they lose valuable time. This time, they could otherwise spend productively examining patients and generating revenue. In such a scenario, outsourcing the physician credentialing service makes a lot of financial sense.

Professional Handling of Claims and Payments by Experts:

Physician Credentialing Services

As a medical professional, suppose you have hired a third-party entity to undertake your credentialing. In that case, you can rest assured that all the paperwork related to claims processing and ensuring that payments are secured will be undertaken by them knowledgeably and professionally, devoid of errors. 

Getting claims approved by insurance carriers can be tedious and a little complicated. Leaving this job in the hands of experts and experienced to do so will turn out as a strategic move. Moreover, it will prove quite beneficial to your practice.

Physician credentialing services ensure that the entire process of submission of forms and claims and any follow-up required in this regard is carried out meticulously by personnel trained for the same.

Updating Changes to Your Professional Profile:

Your physician credentialing service does not merely undertake a background check on you and verify your details. It also follows through and keeps track of any changes in areas of your functioning. For instance, it updates for any change in location practice, hospital affiliations, etc. 

Imagine informing every known as well as a prospective patient that you are now practicing in a different area. You may have a lot of work to do. Thus, the credentialing service follows such details, and updates your information regularly. So once you have a credentialing service on board, you can forget any headache about intimating new information to those concerned. It will all be taken care of.

Physician Credentialing Services Also Provide Additional Services

Nowadays, you have physician credentialing services that are also into revenue cycle management, maintenance of finance and accounting services, and marketing. They basically offer you a bouquet of services in the realm of administration which takes away a massive chunk of the paperwork that otherwise you would have ended up doing. 

Overall and in the long run, this system simplifies the entire caregiving process for you, so you have all the technicalities of administrative work sorted out under one roof. What’s not to like?

Come, partner with us today, and get more productive in your medical career!

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Nursing Home Billing Guide

Nursing Home Billing Guidelines

Nursing homes are as important as hospitals and other centers of medical care nowadays. They are an equally important factor for ensuring the good health and wellness of citizens of modern American society. This applies more to the infirm and the elderly.

There are different types of nursing homes like skilled nursing facilities (SNFs), Independent Living Facilities, Assisted Living Centers, to name a few. These institutions bill their patient or the patient’s legal appointee for their services. The State has put some guidelines in place for such billing.

Let’s see what these nursing home billing guidelines are and which factors affect the billing process.

Period of Coverage of Bill

The nursing home usually issues a monthly bill for its residents for services it has rendered and medical care it has provided. The resident (or their legal appointee) enters into a contract with the nursing home. This contract offers details about billing frequency.

Mainly, this bill includes the charge of all essential services provided. However, sometimes, it also includes the charge of other associated services.

The billing cycle is the time period (calculated as the number of days – a month, for example) for which each billing takes place. Then, the nursing home may also charge a prorated amount for the month of admission. This means that in case the resident did not start his stay on the first day of the billing cycle, the billing amount equates to the per-day charge of room and board multiplied by the number of days. Sometimes, the care facilities also issue a pre-bill for the cost of the upcoming month.

Level of Care Provided

Assisted Living Centers like nursing homes and SNFs provide different, multiple levels of care based on the requirement of their inpatients. This level of care affects the amount they bill their patients to a significant extent. Further, these levels can broadly be classified into primary, secondary, tertiary, and quaternary levels of care.

A primary level of care provides the very essentials or the basic level of medical care. So, routine testing of a patient’s vitals falls under primary care. Additionally, if you require other specialized doctors to treat you, the primary level of care undertakes this required coordination.

Then there is the secondary level of care. Medical specialists usually provide this level of service. As an example, the primary care physician might treat a resident for common indigestion. But when the physician refers them to a gastroenterologist for further gastro investigation, it becomes the secondary level of care.

Tertiary care is very high, requiring complex equipment and a high degree of medical expertise. Some examples are complex microsurgeries and neurosurgeries. Tertiary care, being complex in nature, is not provided at small, regular hospitals or nursing homes. The nursing home usually refers its patients to specialized tertiary care centers.

Lastly, there is quaternary care which is nothing but an extension of tertiary care. It is a highly specialized level. Experimental cancer trials are an example of this.

Nursing Home Billing Guidelines

Type of Insurance Coverage

There are some Medicare Part A criteria for SNFs. If the medical needs of the patient in question meet these criteria, Medicare as an insurance carrier will pay for up to 20 days of stay in the nursing facility. Some insurance policies cover long-term care in nursing facilities.

Leaves of Absence

This is a factor that also affects the nursing home bill. A resident might need to leave the nursing home for a while. Mostly, they or their proxy will sign the bed hold waiver to reserve their room for them in their absence.

But this implies that the care facility will continue to bill the patient in his absence too. Alternatively, the inpatient could forfeit the bed hold, meaning fewer charges but nonavailability of room as a possibility when the resident returns.

The US Government has also specifically created and issued nursing home billing guidelines for nursing home billing. There are also CPT codes for nursing homes that simplify the billing process. For more information, you can visit Medical Healthcare Solutions, Inc.

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medical billing company services

Medical Billing Company Services to Help You Stay in Business

Are you thinking of taking help from medical billing company services? But, are you not sure how it can work for your business? Let us look at a few points to understand how medical billing company services can help you stay in business.

Assists concentrating on patient care:

Being a qualified doctor and an institutional manager simultaneously is always a problem. Hospitals can spare staff time and secure higher returns by shifting resources away from difficult billing problems toward helping patients. These high-value activities assist the clinic in earning more cash and building a more successful practice with dedicated patient care. 

As a result, medical practitioners can focus on their job the most. They can do so by practicing medicine and treating patients rather than juggling between payers and regulations.

Lessens Billing Errors:

Competent and well-trained medical billers are well-versed in the complexities of claim submission. Taking Medical billing company services will work best here. It’s because those companies make sure that they provide proper training of the processes. Therefore, it helps in driving and assessing the understanding of the domain with the desired excellence. 

Further, these medical billers assure filings and precision while at work. Before sending the claims to the payer, they assess and modify the claims accordingly, which further reduces the number of denied claims for problems.

Saves Money:

One of the key motivations for outsourcing has always been to save money. Hospitals can save money on wages, training, and benefits by delegating medical billing. They can also save money on office supplies, furniture, and technology purchases or upgrades. 

Many customers prefer specialist suppliers because they may get high-quality service at a reduced price. Clients can choose the solution that best matches their needs due to the variable pricing models.

Improves Cash Flow:

Medical billing firms allow companies to maintain a regular cash flow and faster settlement irrespective of their workforce. Allowing a specialized agency to handle medical billing swiftly allows hospitals to gain better economies of scale.

Increases Patient Satisfaction:

Managing a medical practice or an organization necessitates a certain level of expertise to streamline the entire work cycle. It is extremely difficult for small or early-stage medical businesses to separate their active staff into medical billing or other roles. This somehow diverts their attention away from their assigned tasks. 

You can easily outsource hospital billing operations to remedy the problem. Consequently, the clinic staff’s efficiency will be boosted, which will eventually lead to higher patient satisfaction.

Provides real-time data access and strong authentication:

medical billing company services

Another advantage of medical billing company services is that you can receive data and reports promptly. On the other hand, real-time data analytics allows healthcare service providers to acquire in-depth insights into the firm’s performance and what can be handled more or less. 

Furthermore, once all the data has been gathered, the firm will find it easier to make judgments in keeping with the growth techniques. Billing is the process of storing very sensitive and crucial patient information. However, a single data leak or misplacement might result in widespread discontent within the company. This has a lot of negative ramifications as well. As a result, the professionals in the sector to whom you will outsource can readily address these obligations.

Seeking new ways to cut operating costs and improve billing control is the method to go in the ever-changing healthcare industry. Getting competent medical billing company services will only benefit your company. Get in touch with Medical Healthcare Solutions today.

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8 medical billing tips

Collect More from Patients: 8 Medical Billing Tips

Unsurprisingly, medical billing is among the most challenging tasks that healthcare organizations come across. Though physicians are well-trained in handling their patients’ health, there are a number of things to consider to keep up with the revenue cycle

While medical billing is complicated, here are the eight medical billing tips which can help you to sustain the costly work of offering healthcare services.

Tip #1: Develop a clear collection procedure

This is the first and most significant medical billing tip. 

  • Notify patients about the requirements of debt repayment. Provide information concerning their payment responsibilities in their new-patient papers, and nudge them off their duties frequently, particularly when things alter. 
  • Collect complete details of the patient. Such details comprise their address, contact number, email-id, etc.
  • Help the patients recall their co-pay and its importance. Make sure your team knows how to respond to any inquiries a patient may have.
  • To avert claim rejections, bring the proof of insurance with you to each appointment and double-check the person’s eligibility. Much better, to save money on staffing, employ an electronic verification method.
  • Determine what funding methods are accessible to the patient at the moment. Clarify what comes under their payments. For instance, help them to know if credit cards, cheques, or money are accepted and whether installment plans are possible.

Tip #2: Engage in staff training

After establishing a structured and verifiable billing procedure, you must put effort into proper staff training. It’s never a good idea to skip this medical billing tip or think that only the person who files the claims requires training. In addition, ensure that every team member has exact knowledge of their responsibilities and expectations.

Tip #3: Handle claims correctly

8 medical billing tips

  • Never procrastinate in filing claims. Yet, exercise extreme caution to confirm that the claims are accurate and comprehensive. Make it a practice to file all the claims at the end of the day. 
  • Submission of the claim does not refer to the end of the process. Make very sure that all claims are updated until the patients fully settle them. It’s all too easy to get caught up in the daily grind and overlook minor claims.
  • It’s essential to deliver the claim to the correct payer — the one who is accountable for that specific payment. Claims addressed to the wrong recipient will cause delays. They will reject the claim, and then you have to resend it to the correct recipient. Delayed payments have almost the same impact on the revenue cycle as rejected refunds.

Tip #4: Verify Patient’s Insurance

You can check the patient’s insurance upon every visit. In addition, double checking that it is up to date from when they were last seen would help to avoid any further renewal issues. Also, it is important to check eligibility to be sure the patient’s visit is covered by their insurance. This will not only increase cash collection but will also eliminate any bad debt. 

Tip #5: Stay informed

Medical billing standards are continually updating, and catching up with them can necessitate ongoing staff training and technology updates. Keep up with any changes that may affect medical billing processes, and obtain required training. It’ll save you money in the long run if you don’t have to redo claims as often.

Tip #6: Determine problem accounts

By setting clear protocols for dealing with patient finances, you can have the data for identifying possible problems. Adopt methods for identifying problematic behaviors such as delayed payment, consistently denied payments, or variations in contact details. 

Tip #7: Manage denied and rejected claims on time

Screening a claim for mistakes can help to reduce the number of rejections and cancellations. However, if they do happen, make sure to deal with them as soon as possible. 

Maintain contact with a payer agent. They can assist in resolving issues with the initial claim and supply updates on subsequent claims. This can all assist in speeding up the claim modification cycle and reduce the time it takes to reject and resubmit claims.

Tip #8: Hire a trustworthy billing company

8 medical billing tips

This is the must-follow medical billing tip if you are unable to follow the above ones. If you’re having trouble keeping up with current invoicing laws, getting rejections in payments,  have problems delegating responsibilities, etc., then a medical billing company can help you.


All these tips can help you collect more from your patients and on time. For your best medical billing system and to have some more information, Medical Healthcare Solutions Inc. can help you.

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