How Medical Billing Consultants are Crucial to Credentialing with Medicare & Medicaid?


Over the years, Credentialing has become an indispensable thing to medical practitioners’ sustenance and growth; so much so that it is impossible to think of undertaking medical practicing without a valid credentialing from the authorized health agencies. Today, credentialing, as much as a mandatory requirement for commencing and running clinical operations, is also physicians’ passport to attract and retain patients. Moreover, unlike during the pay-for-service era, the job of Credentialing does not stop just with attracting and retaining but far beyond that.  Today, physicians have to contend with Credentialing of a different type – Credentialed with healthcare insurance providers.

Sometime ago, when medical practices had only to deal with either the Federal Government sponsored Medicare or state-wise Medicaid schemes, the process of getting Credentialed was seemingly manageable by physicians themselves. But, as the healthcare industry opened up to private insurance carriers, the task got a bit heavier as they had to deal with multiple insurance carriers along with Medicare and Medicaid. As physicians were treated to a multiple portfolio of reimbursement sources, they started to feel a decline in their ability to bargain positively with these multiple sources. Consequently, this started to reflect negatively on their revenue generation. Eventually, they had no recourse but to opt for specialized Credentialing services from medical billing companies.

While outsourced Credentialing has been able to nullify the adverse effects on medical reimbursements, its significance may once again be re-emphasized as Medicare and Medicaid reimbursement environment is going to be even more stringent post Federal Government’s decision to bring in quantitative and qualitative reforms to Medicare and Medicaid. Given the likely scenario,  physicians will have to seek  outsourced Credentialing  that  can effectively and efficiently steer them through laborious Medicare & Medicaid Credentialing process comprising:

  • Setting up of all Medicare and Medicaid applications
  • Proofing of submitted Medicare and Medicaid errors and omissions
  • Submission of the Medicare and Medicaid application
  • Setting up and submission of all provider assignment forms and documents
  • Following up with Medicare to insure the completion of all required processes
  • Following up with Medicaid / designated agent to insure the completion of all required processes
  • Archiving of all filed documents for future reference (  – by virtue of credible source for Credentialing with Medicare, Medicaid, and prominent private insurance providers – should be physicians’ preferential choice for outsourced Credentialing services. Our process follows tried and tested path: clients set up their account with our firm by utilizing our secure online form. Once the form is submitted, we will obtain the credentialing documentation from the Insurance providers (Medicare, Medicaid, and private insurance carriers) or directly from the Physicians. will then set up all complicated, and laborious process till physician offices are credentialed amicably.

For more information visit: medical billing

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