Credentialing & Contracting
Healthcare Credentialing Services in Orange County, CA
Patients seeking medical help should not have to be burdened with questioning whether insurance companies will cover their medical expenses. Medical practices should not have to be burdened with establishing their legitimacy, however credentialing is necessary for medical providers to become part of any government or commercial payer’s network. Joining a payer’s network can be an essential tool to extending your services to patients that may otherwise not have coverage at your practice.
It is critically important that all providers are credentialed in order to establish the qualifications of its licensed medical professionals, as well as undergo assessments surrounding the practice’s background and services. Credentialing is the process of obtaining, verifying and assessing the qualifications of a medical practitioner. This ensures the practice is equipped with licensure, training, education, experience and other qualifications that legitimize the medical practice.
Without comprehensive credentialing a practice is generally not permitted to treat patients at an in-network level. When processing out-of network claims a payer may choose to only pay part of a claim, which may subject the patient to large financial responsibility in paying the amount insurance did not cover; this is called a ‘balance bill’. In addition to balance bills, most insurance policies carve out higher out-of-pocket costs for their members that seek out-of-network providers, further increasing the risk of financial hardship a patient may be left with. This can create contention between the patient and the practitioner. Here at Acme Billing Solutions, we are here to alleviate this burden for our clients by credentialing each practice so they can focus on taking care of their patients.
Another seemingly daunting task for a medical practice is working out payer contracts with insurance companies. Insurance contracts represent a significant amount of the physician revenue and should be evaluated and negotiated with extreme precision and care. Negotiations with insurance providers are not necessarily hard to do, but they do require time and attention to detail that practitioners should instead be using to focus on offering the best possible services for their patients. Some of the aspects of negotiating insurance contracts include analyzing the contracts by reviewing the primary insurance average allowables for your top services, collecting and providing accurate internal data regarding your services, gaining a clear in-depth understanding of legal documents, and knowing your market share.
Through Acme Billing Solutions’ implementation of the above strategies, we can provide your practice with an improved payer-provider relationship, promote patient satisfaction, and boost revenue for your practice on your terms. The goal with our healthcare credentialing services is to advocate for your business and ensure that all of the seemingly daunting tasks such as healthcare credentialing services and negotiating insurance contracts is taken care of so you can focus on what matters most – your patients.
Billing & Collections
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Investigate & maintain your practice's documentation and records.
Credentialing & Contracting
From in-network negotiations to licensure and training, Acme Billing can help.
Custom Billing Solutions
Whether you are a large scale healthcare provider or an independent practice, we have billing solutions that work for you.
Eligibility & Verification of Benefits
Learn about our free verification of benefits service and how we can help you help clients at the right place & right time.
Denials, Negotiations, & Appeals
Denials & negotiating payments can be exhausting for any medical practice. Let us do the work for you.
Increase Your Practice's Insurance Coverage
While coverage alone does not guarantee full medical access, it is an essential first step, according to the American Medical Association. It is evidentiary and proven that patients who are committed to expanding their health care coverage live longer and healthier lives. In order to expand insurance coverage, it is important to evaluate the different options provided by your employer, which are often tiered based on the level of coverage you need each year. It is also important to encourage state innovation surrounding state-level individual mandates, auto-enrollment or reinsurance in order to maximize the number of people covered, and stabilize health insurance premiums without undercutting any existing patient protections. Another avenue that is important to support is telehealth and remote patient monitoring. This has become an essential, cost-effective and reliable solution to expanding the healthcare system and establishing a system that works well for both healthcare providers and patients.
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Acme's Professional Healthcare Credentialing Services
Our clients at Acme Billing Solutions benefit from our staff’s experience and extensive knowledge of the credentialing industry and our established practice of credentialing. Given the experience we have with providing healthcare credentialing services for our clients, we offer established methods to ensure that each practice we work with establishes the best possible relationships with their payers.
Our credentialing solutions include initial credentialing where we apply for all designated payers, update and maintain the CAQH database, update and maintain the NPI database, establish a 1-year contract with the payers, and follow up until determination is met by all payers. After the initial credentialing, we offer credential maintenance. Credentialing maintenance includes updating and maintaining the CAQH database, updating and maintaining NPI database, applying for re-credentialing, and establishing a notification process to avoid expiration dates in our contracts.
After credential maintenance, we establish new payer credentialing, new office location, hospital appointments, re-appointments, medical licenses and we follow up until determination on all of these fronts. Acme Billing Solutions understands how critical credentialing can be to a medical practice’s reputation and ability to maintain a steady flow of revenue, and therefore we take this process very seriously and ensure that our clients are credentialing correctly and effectively.
5 Ways Acme Will Help Your Healthcare Business
IDENTIFY ISSUES & AREAS OF GROWTH
CRAFT A UNIQUE BILLING STRATEGY
IMPLEMENT NEW PROCESSES & SYSTEMS
MONITOR UTILIZATION & COLLECTIONS
ENSURE CONTINUED COMPLIANCE & CONSULTING
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Expert Credentialing Services from Acme Billing Solutions
As a medical practitioner, establishing relationships with your patients and providing them with the best level of care should be the primary focus. Although this seems obvious, there are unfortunately many tedious processes medical practices have to deal with in order to establish themselves as a trusted medical provider, while also maintaining a steady flow of revenue to your business. At Acme Billing Solutions, we recognize that the wellbeing of your practice depends on dynamic and efficient billing.
Acme Billing Solutions is a full-service medical billing company that was established in order to effectively support healthcare providers with medical billing processes that ensure timely, maximum payouts from insurance companies. Our healthcare credentialing services’ mission is to support your business with best practices when it comes to credentialing, billing, utilization and collections in a collaborative manner.
Our highly skilled and trained team works hard to take the stress of credentialing and billing off of your hands. We understand that you, as a provider, are faced with unexpected challenges and obstacles, therefore we want to be there to help. Our job is to stay current with the latest trends and policies to help guide your team to success, and we want your job to be focused on providing the best level of care to your patients and to not have to worry about billing.
Find out why Acme Billing is the right partner for your healthcare business. Call and get a free assessment: 1.888.909.8055