New Practice

It wasn’t easy for you to start your medical practice. You worried a lot over the elements that went into your decision. It was one of the most challenging decisions you ever made, even more, challenging than the decision to go into Medicine. The risk/reward ratio was daunting. You did it because of your desire for the personal and professional rewards that come from a well-run medical practice. You wanted to be able to “be your boss” and make the decisions that you think best for your patients. So you had to be more than a physician; you also had to be a business person.

Many of the same benefits come from consultancies and management groups such as Medwave, which can support you in your efforts. Medwave advises and assists medical office owners on medical coding, billing, credentialing, and payer contracting best practices. We have management solutions that can improve your efficiency, lower your expenditures and enable you to concentrate on patient care.

We have the resources and expertise in specialized areas and tasks that would take a steep learning curve to handle on your own. Three of the areas in which most medical providers need outside help are medical billing, credentialing, and payer contracting, the essential foundation for establishing a financially viable practice that receives fair reimbursement for the quality care you provide.

Medical Billing

All the procedures of submitting claims to healthcare insurance companies to receive payment for the services provided by a physician make up medical billing. Through this process, the medical attention to a patient is translated into a request for reimbursement to the provider from the health insurance company.

The person or agency responsible for medical billing also follows up the claim to work out any misunderstandings or delays and to ensure that the provider receives prompt reimbursement for the services completed. Good medical billing can mean money to the provider by eliminating repetitive contacts and unnecessary billing and consultation. The professional biller gathers all of the relevant data such as the codes involved, etc,.

The duties of the medical biller vary according to the size of a practice and the complexity of the attention provided. In any event, the medical biller has to enter the charge within a claim and keep track of payment, as well as any necessary follow-up with the insurance provider. Today, many think that it is more efficient and cost-effective to outsource their medical billing. Medwave has years of experience and can be a vital cog to your practice in submitting claims and getting paid quickly and easily.

Additionally, if your medical practice has high enough claim volume, we suggest using our RPA or Robotic Process Automation billing services.

Credentialing

Credentialing is the process of getting the medical practice recognized by public and private agencies, particularly insurance companies. Any medical practice that is in the network of a popular insurance company can be sure of continued patients. It is not easy to get a new practice credentialed.

One large part of the complexity is the requirement by CMS (The Center for Medicare Services) to have timely information and updates about attention to patients. If the standards are not met, the medical practice can lose its credentials and their in-network status with insurance companies.

Medwave is up to date with the requirements to keep your practice’s information in a proper state. The individual practitioner doesn’t have to worry about the changing requirements and reporting duties. Our team works with the practitioner and CAQH (The Coalition For Affordable Quality Healthcare). We do the tedious work so that your patient care, status with the insurance companies, and cash flow proceeds with few obstacles.

If a provider does not have a profile with CAQH, insurance companies will not keep their credentialing active. A skilled professional credentialing team is a boon to the overworked practitioner.

Medwave can also assist the healthcare practitioner to get their NPI, the 10-digit identifying number that is necessary to file billing claims. Practitioners are also helped with linking their NPI with their employer identification number.

The modern physician should look to groups like Medwave for assistance in all phases of medical credentialing.

Payer Contracting

Once your practice is credentialed, the next critical step is establishing favorable payer contracts with insurance companies. Payer contracting is the process of negotiating and finalizing agreements with health insurance companies that determine your reimbursement rates, payment terms, and participation requirements. For a new practice, securing strong payer contracts can be the difference between financial success and struggle. These contracts directly impact your revenue stream and determine how much you’ll be paid for the services you provide to patients.

Negotiating payer contracts is a complex and time-consuming endeavor that requires specialized knowledge of industry standards, reimbursement models, and legal terminology. Insurance companies have experienced negotiators who understand the intricacies of healthcare reimbursement, and without proper representation, new practices often accept unfavorable terms that can affect profitability for years to come. The contracts involve understanding fee schedules, carve-outs, bundled payments, value-based care provisions, and numerous other technical elements that can significantly impact your bottom line.

Our team has extensive experience working with major insurance carriers including Medicare, Medicaid, and commercial payers. We know what constitutes fair market rates for your specialty and geographic area, and we advocate for your interests throughout the negotiation process.

Our payer contracting services include reviewing proposed contracts to identify potentially problematic clauses, comparing offered rates against industry benchmarks, negotiating better reimbursement terms, and ensuring contracts include appropriate provisions for regular rate updates. We also help you understand the implications of different contract structures, such as capitated versus fee-for-service models, and guide you in selecting payer relationships that align with your practice’s goals and patient population.

Additionally, we monitor contract renewal dates and proactively renegotiate terms to ensure your practice continues to receive competitive reimbursement rates as your volume and reputation grow.

Summary: New Practice Set-Up

Setting up a new individual or group practice can be a daunting task and knowing where to start and what information is needed to start bringing in revenue can be a key process in ensuring your practice’s success. Medwave can help you and your business streamline these processes and get your practice up and running.