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.
I’m aware that valuation involves numbers and computations, but what key factors are present in the more lucrative practices?
What helps a practice’s value?
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Is it true that the HIPAA Privacy Rule strictly prohibits the use, disclosure, or request of an entire medical record?
No. The Privacy Rule does not prohibit the use, disclosure, or request of an entire medical record; and a covered entity may use, disclose, or request an entire medical record without a case-by-case justification, if the covered entity has documented in its policies and procedures that the entire medical record is the amount reasonably necessary for certain identified purposes.
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Many of the credentialing software packages available don’t contain applications for every health plan in America. With that in mind, what steps should be taken prior to obtaining software?
Before obtaining or making a software purchase, compare the list of plans in your area with the list of applications the software includes.
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Managed care plans are notorious for losing paperwork crucial to the credentialing process. What can I do to ensure that documentation requested was forwarded, received, and moving along smoothly?
Throughout the credentialing process it’s very important to consistantly follow up on the various timelines of your application and various paperwork.
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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.
Our practice is merging with another group. With so many physicians “sharing the pot,” wouldn’t it be economically feasible for me to go solo?
Private medical practices face significantly greater financial and legal risk today than in the past.
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Some larger medical groups have delegated credentialing. How is delegated credentialing beneficial to me and the group I join?
The quicker you are credentialed, the quicker you have access to the patient base and, consequently, bring in revenue for the group.
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The minimum length of time from application to full approval of privileges in most hospitals is how long? And what are some factors affecting the time required to process a credentialing application?
On average, the process of obtaining hospital privileges will take approximately 3 months. Personal circumstances can affect the time required to complete the credentialing process for both hospital privileging and payor contracting.
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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.
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