The Importance of Medical Billing and Credentialing Services

The Importance of Medical Billing and Credentialing Services

By intellircm 8th Dec 2021 Blog

Properly selecting a medical billing and credentialing services program helps to ensure that all financial transactions in a clinic or healthcare facility are handled correctly. These services facilitate communication between patients and insurance companies and play an essential role in developing your clinics’ credibility rating and increasing the number of patients coming to your clinic regularly for quality care.

IntelliRCM Helps Your Service Grow

Due to the technical complexity and enormous amount of work, combining essential medical service delivery with report tracking is a complex task. However, there are steps you can take to better delegate work to focus on providing quality care. IntelliRCM takes care of the endless amounts of fiscal reports with advanced systems that keep track of all financial transactions. In addition, we carefully review every insurance claim and make sure the medical practice gets paid on time without any loss of revenue for services rendered.

We Offer Insurance Credentialing and Medical Billing Services for the Following Professionals

At IntelliRCM, we offer superior services and guaranteed assistance to a wide range of medical and health care professionals. Our list of professions for performing financial services includes:
  • Doctors
  • Physician assistants
  • Optometrists
  • Chiropractors
  • Physical Therapists
  • Counselors
  • Physicians
  • Urgent Care Facilities
  • Behavioral Health
  • Clinical Labs
  • Psychiatrists
  • Podiatrists

Medical Insurance Credentialing

Nowadays, the healthcare industry relies on health insurance companies to be the primary guarantors of funding for clients, which means that patients don’t pay directly for medical services. Instead, they take the help of an intermediary company. The health insurance company processes the claim, usually with the help of medical claims specialists, and determines the amount reimbursed to the health care institution that provided the service. Unsuccessful claims are rejected by the insurance company, and the medical company is notified that the coverage has been denied. If the claim is denied, the health care facility is required to review the claim, make the necessary corrections, and submit it again. Such claim and denial exchanges may be repeated several times until the claim is fully paid, or until the medical organization accepts an incomplete reimbursement. Thus, the amount of routine work for the medical field has increased, and the interactions between health care providers and insurance providers are expected to increase significantly in the years to come. In many cases, medical organizations delegate billing management to companies that provide medical billing services. IntelliRCM takes care of full-step medical insurance credentialing, which helps you to engage with insurance companies to obtain reimbursement for the provision of medical care to a patient. We act as a backup for medical practices, guiding healthcare providers through the nuances related to health care reimbursement, completing the necessary reporting forms for insurance companies, and tracking reimbursements. So your practice can trust us to handle each clients’ insurance while you focus on providing quality medical care and improving your service.

Medical Billing Services

At first glance, medical billing services may seem complicated to organizations just starting to cooperate with insurance companies. From preparing medical bills to receiving full reimbursement, the entire process may take several months. Healthcare billing regulations are complex and frequently updated. Keeping your staff up to date on the latest billing rules can be difficult and time-consuming, which often leads to errors. Therefore, another important task of a medical billing service is to use their expertise and coding knowledge to maximize insurance benefits. At IntelliRCM, we use our expertise in collecting and processing insured clients’ data to protect patients and practices alike.

The Medical Credentialing Services We Offer

  • Credentialing and recredentialing
  • Dedicated team
  • Compliance
  • Crucial follow ups
  • Portal registration
  • Attestation & Re-attestation
  • Contracting issue and data integrity

What Is Insurance Credentialing?

Physician credentialing is a process that aims to perform primary source verification on each physician in the system to provide accurate data to insurance companies. The credentialing system may verify one’s education, prior experience, licenses, accreditation, certificates, professional liability insurance, history of malpractice, and professional competence. This is a mandatory collaboration point, and the verification is considered compulsory according to the law. So, if the physician wants to bill the insurance company for services rendered, they must go through the credentialing process and be legally authorized to participate in insurance networks. The recredentialing procedure has the same standards as the initial credentialing process, and it needs to be done at least once every three years.

Why Medical and Insurance Credentialing Are Important

Medical and insurance credentialing provides more opportunities for both the physician and the patient. This aspect opens up career prospects, allows the specialist to cover as many insurance plans as possible, and allows patients to take full advantage of their insurance.

The Services We Provide

The spectrum of services offered by IntelliRCM include the following:
  • Individual provider enrollment
  • Group provider enrollment
  • CAQH completion and management
  • Primary source verification
  • Medical staff credentialing
  • Recredentialing
  • Tracking and analytics

Tips on Credentialing

Any physician can use these simple tips to complete the credentialing process. The process can take up to several months, so you should prepare all the reports and information you need about 120 days before the patient appointment date. When filling out the application, make sure you provide accurate and up-to-date information and spend enough time completing the paperwork. Review the sequence of all application steps, regularly check the status of the application, and follow up with payers. If the payment is not processed on time, contact an insurance company representative to resolve the problem. Should any problems arise at any stage, IntelliRCM has a team of credentialing specialists available to assist your practice with the enrollment services, as well as oversee all stages of the health insurance reimbursement process.

Let Us Help You with Medical Billing and Credentialing

The medical and insurance credentialing process is designed to establish a high level of trust between the practice and the patients. IntelliRCM will help you demonstrate your professionalism and take full responsibility for the credentialing process and medical billing procedure. To learn more about our services, contact us by phone, email, or via the contact form on our website.

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