WCH Service Bureau WCH Service Bureau
  • Services Services
    • Medical Billing
    • Provider Credentialing
    • Medical Auditing
    • Real-Time Eligibility
    • MIPS Support
    • Webinars
    • Practice Analysis
  • Products Products
    • Credentialing Application ©
    • iSmart EHR ©
    • PMBOS ©
    • Time Management Program
  • WCH Franchise
  • Company
    • About
    • Our Offices
    • Careers
  • News
    • WCH Insights
    • Healthcare News
    • WCH News
  • Contact Us
  1. Home
  2. > WchNews
  3. > WCHNewsItem
Phone: 888-924-3973 Technical support Pay Now iSmart Login

Credentialing: What They Didn't Teach You in Med School

5/28/2017

Credentialing:
What They Didn't Teach You in Med School

By Olga Khabinskay, WCH Chief Operating Officer

 

WCH helps post-residency graduates navigate the business of medicine, select where to practice and get into closed insurance panels.

Just because you're going to be a great doctor, doesn't mean you will be great at the business of medicine. They're two very different abilities and medical schools these days only teach the medicine part. Unfortunately, they don’t teach new doctors how to choose a practice model, open a business, get into increasingly closed insurance panels or market services to patients.

Do you want to start your own practice, work for a hospital or join an established group? What you might not know is that you need to know the answer to “Will I be able to get onto an insurance panel and bill patients?” before you establish an office or join a practice.

 

Location, Location, Location

 

As a result, the most important decision is location – where not to open – as well as how to find a suitable location based on the ability to get onto insurance panels.

Don’t rush into a lease. Do your research. Explore the area. Study the traffic. Is the neighborhood safe? How competitive is it? How will patients find you? Are the sites you’re exploring close to transportation?

Once you’ve narrowed it down to a few places, work with a credentialing company, like WCH, to find out if insurance panels are open there. If there are already 10-15 other providers with your specialty within a three-five mile radius, you’ll need to prove what sets you apart from the rest or risk being rejected.

That’s where an experienced credentialing specialist comes in. We have strong relationships with insurance representatives. They take our calls. And we know how to package a doctor and present him as a necessary addition to a closed panel.

For example, we have two clients who are podiatrists. One of them is also a surgeon. We’ll have a better chance of getting him into a closed panel because of his additional qualifications.

The phone calls don’t stop there. If an insurance representative tells us a community is oversaturated, we will call all of the area practices listed in the network directory to confirm they are still there.

This worked out very well for one well-respected podiatric surgeon. Our contact at a major insurer said there was nothing he could do because the Jamaica, Queens, neighborhood the doctor selected already had 12 podiatrists. We discovered 25 percent of the offices listed were permanently closed, proved there was now a need in the community, and secured a spot for our client.

 

Don’t Delay

 

Start the credentialing process as soon as you sign the lease. While you’re waiting for commercial carriers you can see patients covered by Medicare and Medicaid, which are always open to new providers.

Some offices introduce themselves to their community during this time with grand opening events featuring free flu shots, screenings, and other complementary services.

While you don’t need credentialing if you don’t bill insurance, you will close yourself off from a significant patient pool. That listing in an insurance directory is a very strong marketing tool. It’s how patients find you.

How to Stand Out and Get In to Closed Panels

  • Pursue additional degrees and certifications – For example, a doctor of physical therapy who specializes in hands, orthotics or prosthetics is a valuable addition to any network.
  • Speak several languages.
  • Specialize in unusual procedures, surgeries or diagnoses.
  • Use sophisticated equipment and provide distinctive services.
  • Work after hours – one primary care physician whose clinic sees patients from 5 pm–12 am got into several closed panels because he filled a gap in after-hours coverage.
  • Find an advocate/credentialing team with experience, contacts, tools and breadth of services.

Credentialing Necessities

  • Commercial insurance requires hospital affiliation, preferably 30 minutes from a doctor’s office.
  • While Medicare and Medicaid do not require a hospital affiliation, a doctor opening a new practice must have a lease agreement. Banks offer medical financial programs that cover the lease, rent, equipment and furniture.
  • If you work with another doctor or practice, make sure to file a W-9.
  • Beware of quick fixes. Don’t let someone convince you to join a practice, see patients, and bill under someone else while you’re trying to get into a closed panel. That’s fraud.
     

 

Room to Grow

 

Find a partner you can learn from and grow with. While a small credentialing company may be able to help with that one step, the relationship ends there.

WCH knows billing, coding, chart writing, and audit, and can consult with healthcare providers on other aspects of practice management. Sometimes it’s just a conversation. We may pick up on something a doctor tells us she wants to do and be able to help her strategize, plan, and connect with other resources.

These days, it's virtually impossible to establish and run a practice alone. We have seen too many doctors try to do everything themselves and fail. It’s important to build a team, find a strong manager and work with professionals who can guide you through credentialing and help you establish effective billing and other office management processes.

Liked the article? Share with friends:

WCH News

January 18, 2023
WCH Accomplishments 2022
AT THE BEGINNING OF THE NEW YEAR, IT IS CUSTOMARY TO  SUMMARIZE THE RESULTS OF THE PREVIOUS ONE. WE THANK YOU FOR YOUR TRUST AND SHARE OUR ACCOMPLISHMENTS WITH YOU.Creden...
December 26, 2022
Professionalism is Not Afraid of Obstacles
Professionalism is Not Afraid of Obstacles WCH is always happy to share its success stories with you. This month, we want to feature a recent story about the journey of our pharmacy specialty cus...
November 07, 2022
NEVER STOP LEARNING
“Education is the most powerful weapon which you can use to change the world”, Nelson Mandela. We are glad that people who gathered at the WCH team share this opinion and are proud that th...
August 09, 2022
Introducing WCH CredyApp
Introducing WCH CredyAppWCH Credentialing team knows all challenges of handling credentialing internally. WCH has done credentialing for over 20 years, helping healthcare providers of various specialt...

Healthcare News

January 18, 2023
Get $26,000 per Employee with Federal ERC Credits
Get $26,000 per Employee with Federal ERC CreditsLike the PPP/EIDL, there is no repayment as it is a tax credit of up to 26,000 per W-2 worker you employed in 2019/2020.It is no secret that the Corona...
December 26, 2022
Cuts in Physician Payments Will Reduce Access to Care
Cuts in Physician Payments Will Reduce Access to Care The MGMA’s data shows that 90% of medical facilities reported likely declines in access to care following the 2023 payment cuts in the ...
November 29, 2022
LockBit Ransomware Campaign: New Suspect
Lockbit ransomware campaign, the variant that has been known to target healthcare in the past, is back on the radar. Thus, the Department of Justice reported that on November 15, 2022, the alleged cha...
November 04, 2022
Warning about the threat of imprisonment for breaking the HIPPA Law
If prosecutors find that providers disregarded PIR (protected information rules) in a way that warrants more punishment than fines and penalties - the doctor faces up to a year in prison on charges of...

Ready to start?

Contact Us
linkedin
⟶ let's start
WCH Service Bureau
Payment options
WCH Service Bureau WCH Service Bureau WCH Service Bureau WCH Service Bureau WCH Service Bureau
Pay Now
Services
  • Medical Billing
  • Provider Credentialing
  • Medical Auditing
  • Real-Time Eligibility
  • MIPS Support
  • Webinars
Products
  • Credentialing Software ©
  • iSmart EHR ©
  • PMBOS ©
  • Time Management Program
Company
  • About
  • Contact Us
  • Careers
News
  • WCH Insights
  • Healthcare News
  • WCH News
Support
  • Feedback
  • Technical Support
  • Privacy Policy
888-924-3973
3047 Avenue U, Brooklyn New York 11229
Fax: 347-371-9968
Follow us:
2023 WCH Service Bureau, Inc.® | Web Design and Programming by WCH Service Bureau, Inc.® | Privacy Notice
Can I help you?
Anna
Anna
Administrative Assistant
Hi, what service does your question relate to?
Medical Billing
Provider Credentialing
Medical Audit
Franchising
PMBOS
iSmartEHR
Eligibility
MIPS Service
Other
What are you interested in?
Let me help you.
Please, leave your contact details and we will answer your question.
Thank you for your request, we will respond as soon as possible.
Let us Help You

Dear Provider,
WCH can help your practice in your credentialing needs! Using a credentialing specialist with the knowledge, expertise and connections that can help position your practice ahead of time. Let us help you today! During credentialing process WCH becomes your external credentialing department for all communications, submissions, follow up and any other questions that will come up during the process.

WCH Specializes in:

  • All individual Medical specialties
  • Mobile IDTF
  • Single & Multispecialty Groups
  • Urgent Care, Labs, DME, Pharmacy
  • Article 28, 32, 31
  • Revalidation, Reinstatement &
  • Exclusion
We help Providers in All States! WCH provides Clarity, Comfort and Security in your Practice.
Let us Help You
Wch SErvice Bureau

Medical billing services offered by WCH Service Bureau go far beyond the usual understanding of billing.

 

What we offer is not just excellent professional billing and collection services. We also stand as guardians of your reimbursement and compliance with federal, state laws and regulations as well as private insurance policies and procedures.

 

Do it right! Do it with WCH!

Let us Help You
Wch SErvice Bureau

Periodic medical chart auditing is vital for any healthcare provider and medical practice. Let the professionals evaluate your coding, billing, and documentation practices! Our auditors are AAPC-qualified CPMAs (Certified Professional Auditors) and CPCs (Certified Professional Coders). We perform comprehensive Chart Auditing. We can do the following services for you:

  • Identify areas of risk leading to upcoding or downcoding and medical coding accuracy;
  • Ensure that coding practices are compliant with the regulations set forth by private and government payers;
  • Evaluate Incident to guidelines and services performed on collaborative premises;
  • Perform Analysis of Denials/Duplicate billing /Appeal process/Modifier usage;
  • Review Front Desk work including but not limited to: Eligibility verification/Benefit maximums verification/Excluded services verification/Authorization process/Patient responsibility (deductibles, copays, coinsurance)/Coordination of benefits;
  • Evaluate Insurance plans participation and consistency of contracted rates;

Do it right! Do it with WCH!

Try WCH PMBOS
Request information
Perfect! Please fill in the form

What service does your question relate to?

Let us Help You
Wch SErvice Bureau

Do it right! Do it with WCH!

REQUEST FREE DEMO
Planned number of Providers : *
Specialty : *
Job Role : *
Perfect! Please fill in the form
Perfect! Please fill in the form
Have any questions? Please contact us practiceanalysis@wchsb.com
Leave us a feedback
 
Thank you
for your feedback!
Wch SErvice Bureau

Thank you for your interest in our company!
Our team will process your request and will respond as soon as possible during regular working hours.

Subcribe
Subcribe Subcribe
 
Our site uses cookie.

This site uses cookies for analytics, personalization and advertising. By continuing to browse it, you agree that we use of cookies. To find out more or change your cookie settings click here.