The Importance of Maintaining Credentials

In today’s Managed Healthcare system, out-of-pocket doctor-patient relationships are fading away and being replaced with flat-rate reimbursements that are payable through insurance. While it may seem counterproductive for a doctor to compromise his rates for a higher volume of patients, obtaining insurance coverage has become a make-it-or-break-it necessity in the field. Studies prove that most Americans do not even have $1000 in the bank to pay out-of-pocket for any emergency, including medical services.

Furthermore, because insurance premiums are rising and Americans are paying more than ever to meet mandatory coverage, they want to make use of their insurance whenever possible. Insurance is also covering more areas of healthcare than ever before. Medical insurance must cover previously existing conditions, drug and alcohol rehab programs, mental health care, and may even cover alternative therapies and previously uncovered services, such as acupuncture, chiropractors, emergency room visits, and physical therapists.

How Do Doctors Obtain Insurance Credentials?

In order for doctors to obtain credentials from an insurance provider, they have to pass a screening process to obtain what is termed “Medical Credentialing.” At ContractingProviders.com, we help reduce your application rejection rates and negotiate the maximum premiums. We also manage all the documentation and submit the applications for you. All we need are key documents that each insurer may require to screen your practice for admissibility, such as W-9 forms, DEA numbers, proof of insurance, and licenses.

Many health insurance providers are pretending that they are closed to applicants as a polite alternative to flat-out rejection letters. However, the majority have simply become hypercritical of which doctors they will affiliate with to ensure the best value for their patients. Obtaining approval with multiple insurance companies to accept a broad spectrum of patients requires special skills and experience. Nevertheless, ContractingProviders.com is able to offer our Medical Credentialing” outsource maintenance services for less than $75 month.

We connect you with numerous insurance providers and save you the hassle of following up with them during lengthy application processes. Some processes can take 9 months or more and leave you guessing about what to do next. We file any appeals without additional charge if you are rejected for any reason. In some cases, we can identify errors regarding the decision and clear them up to win you approval.

Lack of Out-of-Network Reimbursements

Another major trend in the health insurance field is the lack of out-of-network reimbursements. Patients today are being forced to rely solely on the healthcare providers associated with their health insurance company. Doctors have to face the reality that they are being denied the bulk of business due to such exclusive contracts. The only way to reclaim that business is to obtain credentials and contracting from the healthcare providers.

This type of exclusive contracting of services is nothing new. Most stores are required to exclusively carry the merchandise of a particular distributor. If they violate the terms, then they face stiff penalties. While some distributors may leave the door open for select local goods that draw in crowds to also sell their products, few distributors are willing to negotiate beyond that. This ensures that their products do not face any competition or inferior perception issues.

The patients who choose out-of-network providers are, likewise, often penalized with additional fees if they do so. In order to benefit from this trend in the medical industry, you have to ensure that your practice is on the right side of the fence. It is impossible to buck the trends that are being mandated by law and shaped by politics.

The only way to ensure the long-term survival of your practice is to partner with as many insurers as possible. The insurers then work to ensure that your services are presented as the best alternative as opposed to other providers outside of the network. In this sense, the lack of out-of-network providers is a negative trend only if you are on the wrong side of it.

And when you hire us, we are able to provide the competitive edge that you need to pass the strict scrutiny of Medical Credentialing gatekeepers. Our services add that touch of error-free professionalism that can persuade providers and make the screening departments’ jobs easier. Outsource maintenance of your affiliate contracting to us and eliminate the worries.

Retaining Out-of-Pocket Patients

Your out-of-pocket patients will always be there if you continue to deliver the high quality of services that they require. And you can even provide them the same additional level of attention if they are paying a higher premium than negotiated insurance flat rates.

But when you are able to contract with major insurers, it is also easier for you to recommend a full range of services that patients may not otherwise be able to afford. And you never have to gouge any one customer because you will accumulate sufficient income by keeping busy and treating a higher volume of patients without frittering away endless dollars on pointless advertising.

It is pointless to spend a lot of money on advertising your services if the potential market is non-existent. We have already covered the scarcity of wealthy out-of-pocket customers. Unless you provide some exceptional service that is not covered by insurance that people absolutely need you alone to solve, the patients will always choose one of the providers in their network.

Managed Healthcare and the Affordable Healthcare Act have completely changed the game for medical practitioners. Mandatory healthcare coverage has made cash-in-hand customers virtually extinct. Although some practitioners, such as cosmetic surgeons, like to offer financing programs for large medical bills and partner with lenders, they still try to bill anything they can under medical necessity. They accomplish this by citing any potential cancer risks or other major health concerns involved in a treatment, scar removal, surgery, etc.

Contact Us

If you want a one-stop-shop solution to obtain and maintain credentials with insurance companies, look no further than ContractingProviders.com. Our savvy dot-com business model keeps our overhead down and allows our team of experts to handle all your credentialing needs for under $80 a month. If you obtain even one customer, as a result of our services, the value of customer acquisition has paid for your annual bill at least ten times over.