Everyone from patients to business partners wants to know that the healthcare professional they’re working with is credentialed. Why credentialing is important for healthcare professionals? Here are five valuable reasons you need to consider:

Credentialing helps practices comply with regulations

There are many laws and regulations governing healthcare, and credentialing helps practices make sure they’re in compliance. For example, the Health Insurance Portability and Accountability Act (HIPAA) requires that only credentialed healthcare professionals have access to protected health information (PHI).

Why Credentialing is Important for Healthcare Professionals?

Quality of Care

When a healthcare professional is credentialed, it means they’ve met specific standards and have been vetted by their peers. This helps to ensure that patients receive high-quality care. When you are a preferred provider for health insurance companies, your practice has access to a larger pool of patients.

Credentialing Can Increase Reimbursements

If a healthcare professional is credentialed, they’re more likely to be reimbursed for their services. This is because credentialing shows that the healthcare professional is up-to-date on their training and meets the standards of care set by insurers. You need this to get paid! When your office staff is busy chasing down payments, it takes away from time that could be spent seeing patients. It also delays payments, which can impact your cash flow.

Credentialing Can Help Practices Save Money

Why credentialing is important for healthcare professionals? The credentialing process can be time-consuming and costly, but the long-term benefits of credentialing are worth the investment. Credentialed healthcare professionals can save practices money by reducing the need for duplicate testing and by avoiding potential penalties for non-compliance with regulations.

Credentialing Helps Practitioners Hospital and Medical Facility Privileges

Credentialing is often required for healthcare professionals who want hospital or medical facility privileges. This process helps to ensure that only qualified practitioners have access to these facilities. To gain entry into top facilities, you need to be credentialed.

Why Your Practice Needs Help With Credentialing

The credentialing process is important for healthcare professionals because it helps to ensure that they are meeting the standards set by regulators and insurers. Credentialing also helps to verify the qualifications of healthcare professionals, which can lead to increased reimbursements and better quality care for patients.

Unfortunately, the credentialing process can be time-consuming and complicated. That’s why it’s crucial to partner with a credentialing services company that can handle the process for you. This will save your staff time and reduce the risk of delayed or lost payments. When you’re looking for a credentialing services partner, choose one with experience in your state and with your type of practice.

AMS Solutions is a national leader in healthcare credentialing. We have over 20 years of experience working with practices of all sizes and specialties. Our staff can help your practice with all aspects of credentialing, from initial application to ongoing maintenance.

Benefits of Working AMS Solutions for Credentialing Services

There are many benefits of working with AMS Solutions for credentialing services, including:

– A team of credentialing experts who understand the process and can help you avoid common mistakes

– A cloud-based system that makes it easy to track your applications and renewals

– discounts on credentialing services for members of our partner organizations

– A dedicated account manager who will work with you to resolve any issues.

Credentialing is a critical process for healthcare professionals. It helps ensure that only qualified practitioners have access to hospital and medical facilities, saves practices money, and can increase reimbursements. When your staff is busy chasing down payments, it takes away from time that could be spent seeing patients.

Help your practice run more smoothly by outsourcing your credentialing needs to AMS Solutions. If you’re looking for help with credentialing, contact AMS Solutions today. We’ll be happy to answer your questions and provide you with a free quote.

Getting reimbursed for behavioral healthcare services can be a struggle.  The complex maze of insurance rules and regulations makes submitting behavioral healthcare billing difficult and frustrating.  This problem results in only approximately 85 percent of claims being paid.  For some, using a billing service can save their businesses.

Billing Rules Explained

Any insurance healthcare billing system is set up to ensure that real claims get paid fully and efficiently while fake or inflated claims are weeded out.  Large group practices usually have a dedicated staff for billing; smaller practices often use third-party billing services. For service providers trying to get paid, figuring out how to comply with those systems is vital to staying in business and running a practice.

Differences from Medical Billing

Behavioral services billing differs from medical billing because the underlying services are so different.  A specific treatment or test is billed at a specific rate in medical settings.  In contrast, in behavioral services, billing applies to therapy, medical management of patients’ illnesses, and psychological testing.  Insurers’ rules set the reimbursable length of a session, how many sessions per week they’ll cover, and usually a maximum number of sessions that will be reimbursed.  These rules do not change based on the client’s need for longer sessions or more of them.

Most of the time, a mental health professional will wait at least 30 days for reimbursement of a submitted claim.  Also, unfortunately, service providers who contract with insurance companies usually cannot bill for the balance remaining after the insurance company pays.  The balance is simply written off.

Clients’ insurance coverage for behavioral care changes frequently.  Service providers should be sure that clients know they should inform the provider of such changes.  Often, however, even the client isn’t aware of changes.  Thus, you as the provider should check your clients’ coverage frequently to see if you need to make changes in your billing practices.  It is better to change your treatment plan than to implement it and find out it won’t be reimbursed.

When considering how to handle your client payments, think about any given insurer’s pre-approval rules and their limits for payments.  Make sure you understand the length of the session they will cover and the number during each billing period and over the life of the illness.  The more you work with given providers, the more likely you are to do things as they like them.

How a Billing Service Can Help

You can avoid many of these headaches by using a behavior healthcare billing service.  They can improve your collection rates of return and get you to nearly 100 percent successful collections.  Services they can offer include:

Tracking patient demographics, onboarding, and insurance verification

It’s not enough just to have patients.  You have to properly bring them on board, know who they are, and make sure they have insurance that covers your services.  A behavioral healthcare billing service can handle this for you, leaving you free to provide services to these new clients.

Managing accounts receivable

Behavioral healthcare billing services let you focus on treatment while they manage your accounts receivable.  As they do billing and receive revenue, the service will discover problems and remedy them before real damage to your practice results.

Obtaining physician credentialing when required

A healthcare billing service can make sure that all of your workers are properly credentialed.  They can also ensure that each service billed was performed and billed by a professional with the appropriate credentials for that service. As you add new professionals to your practice, it’s vital to ascertain that they are properly credentialed to provide those services.

Auditing codes for maximizing revenue

Proper coding is the heart of getting paid in healthcare billing.  When you have a patient in your office, you record the visit or service in the client’s file.  You include an explanation of why you gave that specific service, test, or procedure.  Your healthcare billing service will work from that record to review and document your clinical records to ensure that the file is complete and that they obtain any missing information.  The service will then apply the correct ICD diagnosis and CPT or HCPCS treatment and procedure codes to the patient’s condition and file the claim.  The billing service then compiles this information under a chargemaster capture code that sets the standard prices for services and procedures you provide.

Reporting on revenue collections

Your healthcare billing service can keep you current on the success of your collections by providing periodic reports on revenue collections.  If there are problems with particular insurance companies or patients, these reports will reveal that to you.

In sum, behavioral healthcare billing allows you, the mental healthcare professional, to concentrate on providing behavioral healthcare.  Meanwhile, someone else devotes time and effort to ensure that you are well-paid for doing so.

8 Reasons You Should Outsource Medical Billing

Medical practices of all types and sizes are tasked with helping patients feel their best. Ideally, the success of any doctor or group practice should be measured solely by the level of care received by the doctor. Still, the importance of revenue cannot be understated.

It only takes a few medical billing errors to result in an unstable revenue workflow. A disruption in cash flow can be detrimental to any size of medical practice. Because of this and the workload of medical billing, many practices outsource this service to a medical billing company. The benefits are undeniable.

A medical billing company can help the medical practice:

1. Provide the attention and expertise needed to handle the billing load.

 Medical billing companies are experts at handling billing. They know the intricacies of private insurance companies, Medicare and Medicaid. They are educated on the ever-changing coding and billing regulations. Many companies have account specialists for different types of medical practices. In short, the medical billing specialists act as the bridge between the medical practice and the insurance company, making sure the practice gets paid.

2. Keep the focus on patient care and the provision of quality healthcare.

 After all, patient care should be the top priority in your practice. Medical billing companies handle patient and payer inquiries so you can stay focused on what’s important – allowing your staff to hone in on their day-to-day functions with patients.

3. Process claims efficiently and quickly.

 Medical billing companies know the ins and outs of medical coding and insurance companies since that is their expertise. Because of this, they can process claims at a much faster and more efficient rate.

4. Maintain the biller-patient relationship in a trust-filled atmosphere.

 Because medical billing companies handle all of the inquiries from patients and payers, your focus as a medical practice can be solely on the patients’ medical needs. This creates a trust-filled atmosphere without the stress of financial worry.

5. Increase cash flow for the practice.

 Medical billing companies work with your practice to ensure consistent cash flow and optimize revenue potential. Claims are constantly being processed and filed by an outsourced service. If you have in-house billing and one employee is out on vacation or sick for any amount of time, your claims will get backlogged. Backlogged claims disrupt cash flow.

6. Increase revenue.

 The specialists can improve the practice’s overall revenue performance by bringing money that may otherwise go to collections. By outsourcing this area of work, you can have a more controlled and sustainable approach to revenue cycle management.

7. Provide peace of mind for the medical practice owner.

 The medical practice owner can feel a sense of peace once they decide to work with a medical billing company. They don’t have to worry about their in-house specialists staying up to date on medical and billing codes or insurance claims. They also don’t have to worry about staying up-to-date on software.

8. Save money on office space and salaried employees.

Outsourcing medical billing is the perfect solution for a practice that does not want to hire and maintain billing personnel. A lot goes into having your in-house billing department- from training costs, benefits, insurance, and payroll, to hardware/software installation costs. Medical practices can also skip costs on office supplies and furniture.

When medical practices don’t have to worry about billing, they can focus on what matters. Regardless of company size, medical billing outsourcing is a fantastic solution for your practice. Outsourcing medical billing can eliminate interruptions and distractions that would otherwise prevent you from reaching your potential. It also scales with your business, so growth is possible and manageable.