Credentialing process can be made simple

May 1, 2010

Credentialing a new doctor with third-party payers (including Medicare) is a tedious but necessary process. Even small mistakes can result in setbacks - even worse, application denials - all of which can rob dermatology practices of precious revenue, experts say.

Key Points

As operational manager at Dermatology Billing Associates, which specializes in billing for dermatology practices and handles about 135 clients, Robin Brown, C.D.C., knows how to navigate the credentialing process.

One of the most important aspects of efficient credentialing is to know which forms to use - especially when it comes to Medicare, she says.

If a dermatologist is a sole proprietor, meaning he might have physicians working with him but none are owners of the practice, he would apply for Medicare credentialing by filling out the CMS-855I. A dermatology practice that is owned by more than one doctor would complete the CMS-855B.

"If the doctor is a sole proprietor and the other doctors are employees, he still has to get a group number from an insurance carrier for the facility," Ms. Brown says.

Many doctors do not know that they have to form a group when they have more than one provider.

"There are still doctors out there today who have added providers to their practices and have never brought together a group or applied for a group number," says Inga C. Ellzey, M.P.A., R.H.I.A., C.D.C., president and chief executive officer of Inga Ellzey Practice Group and Dermatology Billing Associates, Casselberry, Fla. "That is incorrect."

Streamlining tips

Here are some other tips and tricks to help you streamline the credentialing process:

Dermatologists must also use their tax identification numbers and not their Social Security numbers.

Ms. Brown calls the appropriate state provider enrollment for Medicare every two weeks when she has applications in the pipeline. "It takes them 45 days to get an application processed, but if you keep calling and they see that you are calling, things tend to be done a little faster," she says.

Remember: No approval equals less revenue. "You are not going to get paid from the insurance company until that credentialing process has been completed. Other than Medicare, the commercial policies will not let you retroactively bill, so until you are credentialed, you are seeing patients out-of-network, so to speak. Medicare only lets you retroactively bill 30 days from the date of the application. So, you have to make sure that there are no snafus in the process that you can avoid," Ms. Ellzey says.