CareerPhysician

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In the Business of Medicine community, each resident, fellow or physician will walk away with an understanding of the key components of running a successful medical practice such as accounts receivable, managed care and legal and regulatory.

Most Recent Articles

How to Increase the Number of Primary Care Physicians

How to Increase the Number of Primary Care Physicians Demand for Doctors Reaches All-Time High By Art Young Takeaways The recently passed healthcare act will give new insurance coverage to 32 million people Because of a lack of compensation, there are not enough primary care physicians Solutions to this challenge will come from innovative new policies The recently passed healthcare reform legislation in the United States will soon give 32 ...

by admin on 04-26-2011
Managed Care - Market Analysis and Strategy Development

Why is it important? It is Friday night and your high school football team is playing in the state championship playoffs. It is imperative for your team to know: a) the strengths and weakness of the other team b) when to call a certain play to gain optimal yardage c) where the ball must be to score points d) what plays to call to score points e) all of the above The practice you are evaluating is much like your high school football team. The ...

by admin on 03-01-2011
Managed Care - Contract Evaluation

Contract evaluation is a process that every practice should have defined and documented. This can be a simple checklist or as sophisticated as a weighted calculated system. Either way, the process should be documented and utilized by all of the individuals who have contracting authority. Exhibit E is an example if a checklist used to review fee for service contracts. The practice should develop and continue to refine the list as an ongoing ...

by admin on 03-01-2011

Most Recent Terms

American Medical Accreditation Program (AMAP)

A program for individual physician quality accreditation launched by the American Medical Association, in partnership with state and county medical associations and national medical societies. http://www.cmss.org/index.cfm?p=readmore&itemID=1119&detail...

by admin on 05-07-2009
American Board of Medical Specialties (ABMS)

A twenty-four member board who certify and re-certify physicians in their respective specialties. To provide assurance to the public that those certified by an ABMS Member Board have successfully completed an approved training program and an evaluation...

by admin on 05-07-2009
Point of Service (POS)

An insurance model which determines coverage by where care is provided at the time of delivery, rather than by enrollment. POS plans allow enrollees to choose between a network and out-of-network providers. Network or contracted providers are paid on...

by admin on 05-07-2009
Economic Credentialing

The use of economic criteria unrelated to quality of care or professional competence in determining a physician's qualifications for initial or continuing hospital medical staff membership or privileges. (AMA Policy H-230.975) http://www.ama-assn...

by admin on 05-07-2009
Delegated Credentialing

To delegate all or some aspects of the physician credentialing process to outside organizations. http://www.mcres.com/mcrmm08.htm

by admin on 05-07-2009
Credentialing Verification Organizations (CVOs)

An organization responsible for checking the credentials of medical professionals and confirms they are qualified to seek and/or maintain privileges or participate with managed care plans. An organization whose primary responsibility is to ensure no impostors...

by admin on 05-07-2009
Managed Care Organization (MCO)

Entities that serve Medicare or Medicaid beneficiaries on a risk basis through a network of employed or affiliated providers. The term generally includes HMOs, PPOs, and Point of Service plans. In the Medicaid world, other organizations may set up managed...

by admin on 05-07-2009
Credentialing

The process of giving evidence of your medical capabilities to the organizations that give you authority to and/or pay for you to practice medicine. It ensures that only qualified individuals are allowed to practice, minimizing liability for hospitals...

by admin on 05-07-2009
Credentialing File

A file or files containing a copy of just about every official document pertinent to the physician, to be used in the process of substantiating a physician's credentials. http://www.ascrs.org/publications/ao/ae10_4_georgian.htm

by admin on 05-07-2009
Primary Source

The original source of a specific credential that can verify the accuracy of a qualification reported by an applicant. Examples include medical school, graduate medical education program, and state medical board. The credentialing process and primary...

by admin on 05-07-2009
Values

Intrinsic and extrinsic things that are important to you, like achievement, status and autonomy. Intrinsic values are related to the work itself and what it contributes to society. Extrinsic values include external features, such as physical setting and...

by admin on 05-07-2009
SPs, SJs, NFs, and NTs

Myers's sixteen types into four groups, personally configured to show temperament, character, personality, and predisposition to develop certain attitudes and not others. http://keirsey.com/pumII/temper.html

by admin on 05-07-2009
Utilization

Use of services and supplies. Utilization is commonly examined in terms of patterns or rates of use of a single service or type of service such as hospital care, physician visits, prescription drugs. Measurement of utilization of all medical services...

by admin on 05-07-2009
Utilization Review (UR), Utilization Management (UM)

Evaluation of the necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities. In a hospital, this includes review of the appropriateness of admissions, services ordered and provided, length of a stay, and...

by admin on 05-07-2009
Triple Option Plan

Also referred to as a "cafeteria plan", TOP's offer subscribing employees a choice between regular indemnity plans, HMO or PPO plans. During "open enrollment periods" they have the option of switching coverage plans. CareerPhysician

by admin on 05-07-2009

Most Recent Questions

Are there professional credentialing services to help me in the process? Are there any for non-US, international residents?

The Federation Credential Verification Service (FCVS) from the Federation of State Medical Boards is one, and The Universal Credentialing DataSource system developed by the Council for Affordable Quality Healthcare is another. The AMA also has a fairly...

by admin on 10-10-2011
Under the theory of negligent credentialing, Managed Care Organizations (MCOs) are responsible and can be held liable for what?

MCOs are responsible and can be held liable for exposing an injured subscriber to an unqualified provider by failing to conduct a proper credentialing review. They also undertake the risk that subscribers can look to collect damages when the subscriber...

by admin on 09-07-2011
Why would an insurance carrier include personality assessment tests as a condition of policy renewal?

There are many things that contribute to lawsuits being filed against physicians, but there have been several studies in recent years that connect personality with lawsuits. Researchers who have studies physician personality traits expect to see more...

by admin on 06-28-2011
If I'm acquiring a practice am I generally better off in an assets purchase or a stock purchase?

It's usually more desirable to purchase the assets only (excluding the liabilities or equity) rather than the stock in a practice acquisition, since the assets can be depreciated but the stock cannot.

by admin on 06-13-2011
Why is it important to keep credentialing files?

The term credentialing, when used in conjunction with a physician's practice, is the process of substantiating a physician's credentials with required documents such as a state license, diploma, continuing education credits, third-party payer...

by admin on 05-23-2011
What is my group practice really worth and who is most qualified to appraise it?

There are a number of professionals that provide excellent services related to medical practice valuations. Due to the complexity and level of financial risk involved in buying or selling an established practice, shareholder ownership in a Group, or entering...

by admin on 04-24-2011
What are the disadvantages of tackling the credentialing process myself?

Physician credentialing is a laborious process. A doctor must present credentials to every hospital and health plan that he or she wants to affiliate with. A hospital or health plan committee decides whether to grant privileges based on the documentation...

by admin on 04-12-2011
Does "Goodwill" mean more than having returning patients?

Goodwill is made up of many components, including the tendency of patients to return to the same place of business for a given service, and the patterns of physicians, optometrists, opticians and patients to keep referring to the same practice. This expectation...

by admin on 03-21-2011
As a physician, what are some of the things that I should look for in choosing a managed care organization?

The trend for the future includes a focus on “customers/patients”, emphasizing preventative care and efficiency. The adoption of Information Technology is also becoming extremely important.

by admin on 05-17-2009
What happens to my patients if my physician group or I go out of business?

If your patients is being treated for an acute condition, a serious chronic condition, are in the second or third trimester of a pregnancy or are hospitalized, HMO’s are required to provide your patient access to you for a certain amount of time...

by admin on 05-17-2009
Will I be allowed less time with my patients if I participate in Managed Care?

The assumption is that managed care has eroded patient confidence through many mechanisms, including forcing doctors to spend less time with patients. Recent studies indicate that in fact physicians are actually spending more time with patients due to...

by admin on 05-17-2009
If I am the primary care physician, what is my liability if I refer a patient to another physician?

Whether you are the referring or the consulting physician, you will be held responsible for the care of a patient who is under your treatment. To safeguard your patient's health and to minimize your risk of liability, take the following steps to communicate...

by admin on 05-17-2009
If I chose to remain “independent”, what sort of downside can I expect?

Downsides include fewer referrals and responsibility for all aspects of your business including scheduling, billing and possibly lower gross income.

by admin on 05-17-2009
Must I follow treatment guidelines or practice protocols as part of a managed care organization?

Every managed care organization is different, but many view guidelines as rigid routines rather than flexible aids to good practice. You would be wise to check with your managed care organization to determine the intent of the guideline or protocol.

by admin on 05-17-2009
Which plan type, e.g. PPO, HMO, etc. is more likely to offer me a higher and stable price for services?

HMOs still generate more income than PPOs do. The median percentage of gross income from capitation increased for FPs, internists, and ob/gyns, dropped for GPs, and remained the same for pediatricians. The strength of capitation in some markets—coupled...

by admin on 05-17-2009

Most Recent Courses

Practice Management System Reports

Practice Management System Reports on 12-12-2009