A single incorrect modifier can turn a perfectly valid $500 claim into a $0 denial. Even worse, most practices make this mistake dozens of times each month without realizing it. The claim gets denied, staff spends hours working the denial, and the practice either writes off the revenue or faces a lengthy appeal process. All […]
Billing Modifiers, Claim Denials, Medical Billing Modifiers, Medicare Modifier XE, Medicare Modifier XP, Medicare Modifier XS, Medicare Modifier XU, Medicare Modifiers, Modifier 25, Modifier 59, Modifiers
The work history section of your CAQH profile causes more credentialing delays than any other part of the application. It’s not because the concept is difficult. You simply list where you’ve worked for the past ten years, right? The problem is that CAQH demands a complete, gap-free accounting of your professional life, and most providers […]
CAQH, CAQH Application, CAQH Errors, CAQH Mistakes, Credentialed Quickly, Credentialing, Credentialing Bottlenecks, Credentialing Delays, Credentialing Denials, Credentialing Errors, Credentialing Mistakes, Locum Tenens
How Long Does Provider Credentialing Typically Take? Standard provider credentialing takes 90 to 120 days with most insurance companies. Medicare enrollment through PECOS typically requires 60 to 90 days. Medicaid processing times vary significantly by state, ranging from 30 days to 120 days. Commercial payers like UnitedHealthcare, Anthem, and Cigna generally process applications within 90 […]
CAQH, CAQH Mistakes, CAQH ProView, Credentialing, Credentialing Criteria, Credentialing Delays, Credentialing Denials, Credentialing Difficulty, Credentialing FAQ, Credentialing Management, Credentialing Optimization
Radiology billing requires precise coding to ensure proper reimbursement for diagnostic imaging services. Running a standalone imaging center or providing radiology services as part of a larger healthcare practice can be challenging. So, knowing which CPT codes to use makes all the difference between getting paid promptly and facing claim denials. This guide walks you […]
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If you’re a healthcare provider trying to get credentialed with insurance companies, you’ve probably heard about CAQH ProView. This online database helps streamline the credentialing process by allowing you to enter your information once and share it with multiple payers. Sounds simple enough, right? The reality is that small mistakes in your CAQH application can […]
CAQH, CAQH Application, CAQH Attestation, CAQH Credentialing, CAQH Errors, CAQH Impact, CAQH Index, CAQH Mistakes, CAQH ProView, CAQH ProView System, Credentialing, Credentialing Challenges
The Initial Request A behavioral health practice approached Medwave with a specific need. Credentialing services that could handle their six-state telehealth operation. What started as a simple inquiry revealed a much bigger story about the real-world challenges of expanding virtual care across state lines and the administrative burden that comes with it. The practice had […]
Credentialing Telehealth, Multi-State Telehealth Credentialing, Multi-State Telemedicine Credentialing, Revalidation, Telehealth, Telehealth Credentialing, Telehealth Credentialing Specialists, Telemedicine, Telemedicine Credentialing
The way providers get paid is shifting from how many tasks they perform to how well those tasks actually help patients. For decades, the primary method was Fee-for-Service (FFS). In that old model, a clinic or hospital received a check for every blood draw, every X-ray, and every office visit. While that sounds straightforward, it […]
Hospital Reimbursement, Value Based Care, Value-Based, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Care Models, Value-Based Models, Value-Based Pricing, Value-based Reimbursement
Healthcare regulatory updates arrive with clockwork regularity, each bringing new requirements that practices must decode and implement. Rather than getting lost in bureaucratic language, medical practices need clear guidance on what these changes mean for daily operations, revenue cycles, and patient care. Each section provides actionable strategies practices can deploy immediately to ensure compliance while […]
CMS Fee Schedule, Contract Negotiation, Contracting, Contracting Fee Schedule, Decoding Payment Changes, Healthcare Policy, Healthcare Regulatory Changes, No Surprises Act
Staying on top of enrollment requirements is essential for keeping a medical practice running smoothly. PECOS has become the backbone of Medicare enrollment, replacing outdated paper processes with a streamlined digital system. Beyond just being a requirement, PECOS offers real advantages that can save you time, reduce headaches, and protect your practice. Below, we document […]
Centers for Medicare & Medicaid Services, CMS, Medicare, Medicare Billing, Medicare Credentialing, Medicare Enrollment, Medicare In-Network, Medicare PECOS, Medicare Reimbursement, PECOS, PECOS 2.0
You’re sitting at your desk, staring at another credentialing application that’s weeks overdue. Your office manager is juggling three other urgent tasks. Your new physician is frustrated because they still can’t see patients. And you’re wondering… is there a better way to handle this? The answer might surprise you. After 25+ years in medical credentialing, […]
Cost-Benefit Analysis, Credentialing Cost-Benefit Analysis, In-House Credentialing, In-House vs Outsourced Credentialing, Medical Credentialing, Outsourced Credentialing, Outsourced Credentialing Value
Most medical providers accept the first insurance contract they’re offered without realizing how much money they’re leaving on the table. Payer contracting creates direct value for your practice by securing better reimbursement rates, clearer payment terms, and favorable contract language that protects your financial interests. Let’s explore how strategic payer contracting delivers tangible value to […]
Contract Analysis, Contract Management, Contract Negotiations, Contracting, Data-Driven, Data-Driven Negotiations, Healthcare Rate Negotiations, Medical Rate Negotiations, Payer Contract Analysis, Payer Contract Negotiation, Payer Contracting, Payer Contracting Value, Payer Contracts, Payor Contracting, Rate Negotiations
Medical credentialing can make or break a practice’s ability to serve patients and collect payments. The right workflow streamlines the entire process, cutting approval times from months to weeks while reducing errors that cause frustrating delays. Let’s explore the best credentialing workflows and how to implement them in your practice. What Makes a Credentialing Workflow […]
Credentialing, Credentialing Automation, Credentialing KPIs, Credentialing Optimization, Credentialing Software, Credentialing Strategies, Credentialing Technology, Credentialing Tips, Credentialing Workflows, Medical Billing
Medical billing involves tracking claims through multiple stages, from submission to final payment. Two essential tools help practices monitor this process: Electronic Remittance Advice (ERAs) and real-time claim status checks. While both provide information about claim status, they serve entirely different purposes and deliver different types of data at different points in the revenue cycle. […]
Claim Adjustment Reason Codes, Claim Check, Claim Status Check, EFT, Electronic Funds Transfer, EOBs, EOPs, ERAs, Real-Time Claim Status Check, Remittance Advice Remark Codes, Transaction Enrollment
Modifiers can make or break your practice’s revenue cycle. Among all the modifiers in the CPT coding system, Modifier 59 stands out as one of the most important and most frequently misused. This two-digit code can mean the difference between getting paid for the services you provide and watching claims get denied or downcoded. Modifier […]
Articles, CMS, Coding, Healthcare, Healthcare Billing, Medical, Medical Billing, Medicare Modifiers, Modifier 59, Modifier Code, Modifier XE, Modifier XP, Modifier XS, Modifier Xu, Modifiers, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
The 2026 CPT coding updates are here, and they’re bringing significant changes that will directly impact your practice’s revenue cycle. Whether you’re billing for primary care, specialty services, or diagnostic procedures, these updates require your immediate attention. Ignoring them or implementing them incorrectly will result in claim denials, payment delays, and frustrated staff members trying […]
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Financial performance serves as the backbone of any thriving healthcare organization. For medical practices across the country, knowing how much revenue flows in with each patient visit reveals critical insights about overall financial health. Among all the metrics that matter in revenue cycle management, Average Revenue Per Encounter (ARE) stands out as one of the […]
ARE, Average Revenue Per Encounter, Average Revenue Per Encounter (ARE), Average Revenue Per Patient Encounter, Medical Billing, Medical Billing and Coding, Payer Mix
The Merit-Based Incentive Payment System (MIPS) represents a critical component of healthcare’s value-based payment system, directly impacting your practice’s Medicare reimbursements. Yet many healthcare providers find themselves leaving money on the table due to suboptimal MIPS strategies. Knowledge of how to optimize your performance across all four MIPS categories can mean the difference between payment […]
Cost Category, Improvement Activities, Improvement Activities Category, Merit-Based Incentive Payment System, MIPS, MIPS Optimization, Promoting Interoperability, Promoting Interoperability Category, Quality Category
Signing a contract with an insurance company feels like a victory. You’ve negotiated rates, agreed to terms, gotten credentialed, and can finally start billing for services. Many healthcare providers treat contract signing as the finish line, filing the agreement away and moving on to see patients. But that’s where a critical mistake happens. The real […]
Contract Analysis, Healthcare Rate Negotiations, Payer Contracting, Payer Contracts, Payer Negotiations, Payer Relations, Post-Contract, Post-Contract Performance Monitoring, Proactive Rate Negotiations, Rate Negotiations
Allied health professionals form the backbone of modern healthcare delivery, yet their credentialing needs often get overlooked or mishandled. Physical therapists, occupational therapists, speech-language pathologists, dietitians, respiratory therapists, and dozens of other allied health providers face unique credentialing challenges that differ significantly from physician credentialing. Getting these professionals credentialed correctly and efficiently requires specialized knowledge […]
Allied Health, Allied Health Credentialing, Articles, Credentialing, Occupational Therapy Credentialing, OT Credentialing, Physical Therapy Credentialing, PT Credentialing, SLP Credentialing, Speech Therapy Credentialing
Provider credentialing can feel like learning a new language when you first encounter it. The terminology, timelines, and requirements seem designed to confuse rather than clarify. Credentialing is just a systematic process of verifying that healthcare providers have the qualifications they claim and getting them approved to bill insurance companies. Once you know the steps, […]
Credential Maintenance, Credentialing, Credentialing Committee, Credentialing Difficulty, Credentialing Documentation, Credentialing Management, Credentialing Mistakes, Credentialing Timelines, Credentialing Tips
If you’re a healthcare provider looking to expand your practice and serve more patients, getting credentialed with Medicare is essential. Medicare provides health coverage to over 65 million Americans, including people aged 65 and older, younger individuals with disabilities, and people with End-Stage Renal Disease. By becoming a credentialed Medicare provider, you open your doors […]
Credentialing, Credentialing Accuracy, Credentialing Approval, Credentialing Criteria, Credentialing Documentation, Credentialing KPIs, Credentialing Management, Credentialing Optimization, Medicare, Medicare Credentialing
Medical credentialing isn’t a one-size-fits-all process. Every practice situation brings its own set of challenges, timelines, and requirements that can catch you off guard if you’re not prepared. Whether you’re hiring your first provider, opening a new location, adding telehealth services, or managing a practice merger, each scenario demands specific knowledge and careful planning. We’ve […]
Credentialing, Credentialing New Providers, credentialing on-boarding, Credentialing Optimization, Credentialing Pitfalls, Credentialing Problems, credentialing process, Credentialing Services, Credentialing Solutions, Credentialing Use Cases
Moving your medical practice to a new location sounds exciting until you hit the credentialing reality. Whether you’re shifting to a new state, opening a second office across town, or expanding into border regions, the credentialing process can feel like starting from scratch. Honestly…? Sometimes it is. Let’s talk about what actually happens when you […]
Credential Maintenance, Credentialing, Credentialing Applications, Credentialing Challenges, Credentialing Difficulty, Credentialing Optimization, Credentialing Pitfalls, Credentialing Problems, Relocation Credentialing
Medical billing continues to shift at a rapid pace, and 2026 promises to bring changes that will reshape how healthcare organizations manage their revenue cycles. From artificial intelligence taking on more administrative tasks to new payment models gaining traction, the trends emerging this year will impact everyone from solo practitioners to large hospital systems. If […]
AI, Articles, Artificial Intelligence, Automated Billing, Automation, Billing, Billing Automation, Blockchain, Blockchain in Healthcare, Blockchain Technology, Cybersecurity, Data Interoperability, FHIR, Health Level 7, HL7, Machine Learning, Value Based Care, Value-Based
If you’re a healthcare provider looking to expand your practice and serve more patients, getting credentialed with Medicaid is a smart move. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. By becoming a credentialed Medicaid provider, you open your doors to a […]
Credentialing, Credentialing Accuracy, Credentialing Approval, Credentialing Criteria, Credentialing Documentation, Credentialing KPIs, Credentialing Management, Credentialing Optimization, Medicaid, Medicaid Credentialing