Credentialing and the New Graduate
With Guest Author Olga Khabinskay, General Manager, WCH Service Bureau Inc.
As new medical school graduates begin preparing for their new career as physicians, it is of the utmost importance to begin focusing on the area of credentialing as soon as possible. Most medical graduates are woefully unprepared for many of the financial aspects of being a doctor because they have intentionally been focused on the technical and humanist aspects of the medical profession. This is why it may be necessary to find someone they can trust to guide them through this process.
Credentialing is the process by which insurance networks, healthcare organizations and hospitals obtain and evaluate documentation regarding a medical provider's education, training, work history, licensure, regulatory compliance record and malpractice history before allowing that provider to participate in a network or treat patients at a hospital or medical facility. Patients come to a doctor with a private and government insurance plans, such as Medicare and Medicaid, that covers part or all of their medical visits, procedures, prescriptions and hospitalization costs. If a doctor is not "credentialed" by the patient's insurance company, Medicare, or Medicaid plans, they will not be paid for their service and cannot submit their medical bills. More information you can read here