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The Final Stage of Credentialing: Manage & Review to Protect Your Practice from Denials
EPISODE SUMMARY
In this episode of The Claim Game, Jeremy and Kathryn Zug dive into the final stage of credentialing: Stage Six, "Manage and Review". While many providers believe that credentialing is a one-time process, this stage is crucial for avoiding unexpected denials and even ejection from payer networks. The hosts compare ongoing credentialing management to maintaining a car after you've bought it, emphasizing that you can't just drive it off the lot and never look under the hood again. They discuss the importance of recredentialing or reattestation, which payers often require every two to three years, and the critical need to keep all your information updated. The episode also highlights the role of Practice Solutions' tools, such as the Credentialing Matrix and the Insurance Contact Reference List, in systematically managing this ongoing process and preventing costly pitfalls.
KEYWORDS
Credentialing, Revenue Cycle Management (RCM), Insurance Denials, Recredentialing, Reattestation, CAQH, Credentialing Matrix, Insurance Contact Reference List, Practice Solutions, The Claim Game, Revenue Cycle, Payer Networks, Done-for-you Billing, Practice Health Check, Hourglass Learning Hub
TAKEAWAYS
Credentialing is an ongoing process, not a one-time event. Neglecting the "manage and review" stage can lead to denials and disenrollment from payer networks.
Proactive scheduling is key to avoiding pitfalls. Providers should regularly review their CAQH account every 6 to 12 months and tag someone in their practice to manage the reattestation dates on their credentialing matrix.
Keep all your information updated with payers. Failing to promptly update changes in your address, services, or provider licenses can lead to denied claims and a payment nightmare.
Use the right tools to stay organized. The Credentialing Matrix gives you a bird's-eye view of every provider's credentialing status, including their reattestation dates. The Insurance Contact Reference List acts as a "living cheat sheet," helping you know exactly who to contact for updates.
Don't let your "set it and forget it" mentality jeopardize your practice's financial health. Consistent, meticulous record-keeping is crucial for protecting your hard-earned in-network status.
A powerful case study illustrates the risks of neglect. One provider was completely wiped from the TRICARE system, demonstrating how a lack of organization and ongoing management can lead to major, time-consuming problems.
CHAPTERS
00:00 Introduction to Credentialing Management
11:04 Common Pitfalls in Credentialing
19:20 Case Study: The Dangers of Neglecting Your Credentialing Management
22:47 Conclusion: Mastering the Metrics
RESOURCES
Learn More About The Claim Game: Visit practicesol.com/podcast
The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.
Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.
Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.
Get full access to The Claim Game at jeremyzug.substack.com/subscribe
View all episodes
By Jeremy and Kathryn ZugEPISODE SUMMARY
In this episode of The Claim Game, Jeremy and Kathryn Zug dive into the final stage of credentialing: Stage Six, "Manage and Review". While many providers believe that credentialing is a one-time process, this stage is crucial for avoiding unexpected denials and even ejection from payer networks. The hosts compare ongoing credentialing management to maintaining a car after you've bought it, emphasizing that you can't just drive it off the lot and never look under the hood again. They discuss the importance of recredentialing or reattestation, which payers often require every two to three years, and the critical need to keep all your information updated. The episode also highlights the role of Practice Solutions' tools, such as the Credentialing Matrix and the Insurance Contact Reference List, in systematically managing this ongoing process and preventing costly pitfalls.
KEYWORDS
Credentialing, Revenue Cycle Management (RCM), Insurance Denials, Recredentialing, Reattestation, CAQH, Credentialing Matrix, Insurance Contact Reference List, Practice Solutions, The Claim Game, Revenue Cycle, Payer Networks, Done-for-you Billing, Practice Health Check, Hourglass Learning Hub
TAKEAWAYS
Credentialing is an ongoing process, not a one-time event. Neglecting the "manage and review" stage can lead to denials and disenrollment from payer networks.
Proactive scheduling is key to avoiding pitfalls. Providers should regularly review their CAQH account every 6 to 12 months and tag someone in their practice to manage the reattestation dates on their credentialing matrix.
Keep all your information updated with payers. Failing to promptly update changes in your address, services, or provider licenses can lead to denied claims and a payment nightmare.
Use the right tools to stay organized. The Credentialing Matrix gives you a bird's-eye view of every provider's credentialing status, including their reattestation dates. The Insurance Contact Reference List acts as a "living cheat sheet," helping you know exactly who to contact for updates.
Don't let your "set it and forget it" mentality jeopardize your practice's financial health. Consistent, meticulous record-keeping is crucial for protecting your hard-earned in-network status.
A powerful case study illustrates the risks of neglect. One provider was completely wiped from the TRICARE system, demonstrating how a lack of organization and ongoing management can lead to major, time-consuming problems.
CHAPTERS
00:00 Introduction to Credentialing Management
11:04 Common Pitfalls in Credentialing
19:20 Case Study: The Dangers of Neglecting Your Credentialing Management
22:47 Conclusion: Mastering the Metrics
RESOURCES
Learn More About The Claim Game: Visit practicesol.com/podcast
The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.
Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.
Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.
Get full access to The Claim Game at jeremyzug.substack.com/subscribe