New Practice

Get Help Setting Up a New Medical Practice

Medical Billing and Credentialing for New Practice Set-Up

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.

You had to face the main financial concerns of startup costs and continuing costs. Before the health care practitioner even starts, he or she has to face licensing and malpractice insurance costs. As far as medical insurance goes, if you’re fortunate you live in Minnesota which has the most affordable insurance rates. On the other hand, it’s much more expensive in states like Florida.

Payroll, rent, utilities, equipment, and supplies are an ongoing expense. Among the continuing costs, one of the most important decisions you will have to make is that of selecting your medical management plan. There are two parts to this important decision: one is to associate with a non-profit professional association in your specialty, and the second is to join and pay for certain systems that can save your time and maybe even money.

One of the main advantages of joining an association such as the Medical Group Management Association (MGMA), American Academy of Family Practice (AAFP) and similar societies for your chosen specialties is to save time. You will not have to research new ideas, or medical and business practice issues. You will be able to learn from the experience of other physicians. The interchange of ideas and suggestions will help you become more competent. Often these interchanges are done online or in another electronic fashion. This makes learning more palatable and less boring at the end of a long day. These programs and interfaces are in themselves training for you in the digital management of your practice that will become more and more important as it becomes more and more mandated by the federal government and most states. These professional organizations have regular conferences and local chapters and also often produce brief interactive video and audio programs as well as notes and protocols. These tools designed by educators will be valuable as self-study means for you and will also help you train your staff and educate your patients.

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 and credentialing 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. Two of the areas in which most medical providers need outside help are medical billing and credentialing.

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.

There’s another related specialty in the medical practice, that of the medical coder. In a small practice, it could be the same person but any medium-sized practice could have an arrangement with a medical consultancy or management group such as Medwave.

The medical coder has the responsibility of reviewing the doctor’s notes about a treatment to assign standard codes to communicate with the insurance company. The standard coding systems may be CPT^®, ICD-10-CM, and HCPCS Level II. The speed and accuracy of the coder are not only directly translated to the financial success of the medical practice. The skill of the medical coder also has a direct influence on the medical outcomes of the patient. The absence of errors and unnecessary double-checking are a benefit to all.

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.

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.