HealthPro RCM
Contracts & Credentialing
Contracts and Credentialing
Using HealthPro RCM for help with your contracts and credentialing can help you save costs on administrative tasks such as billing and collections. We specialize in contract management and credentialing services, offering solutions to streamline and automate the process of creating, reviewing, and tracking contracts. We provide comprehensive credentialing services, ensuring that healthcare providers meet all necessary requirements and are properly licensed and certified.
%
physicians’ working hours are spent on administrative tasks.
Are Contracts and Credentialing Costing You?
Most practices do not associate credentialing as a source of reimbursement issues. However, insufficient credentialing can cause a host of issues that can affect all areas of administration, especially reimbursements. Our team has a detailed process to make sure all your credentialing is organized and complete and will monitor it moving forward to make sure it stays there.
Major Pain Points With Contracts
Complex and lengthy negotiations: Healthcare contracts involve a lot of negotiation and back-and-forth between providers and payers. This can be a time-consuming and frustrating process, particularly if there are disagreements over reimbursement rates or other terms.
Varying payment models: There are many different payment models in healthcare, including fee-for-service, capitation, and bundled payments. Providers may have to navigate different payment models for different payers, which can be confusing and difficult to manage.
Regulatory compliance: Healthcare contracts are subject to a range of regulatory requirements, including HIPAA, Stark Law, and Anti-Kickback Statute. Providers must ensure that their contracts comply with these regulations, which can be challenging and time-consuming.
Regulatory compliance: Healthcare contracts are subject to a range of regulatory requirements, including HIPAA, Stark Law, and Anti-Kickback Statute. Providers must ensure that their contracts comply with these regulations, which can be challenging and time-consuming.
Administrative burden: Healthcare contracts require a lot of administrative work, including tracking claims, managing denials, and submitting appeals. This can be a significant burden for providers, particularly small practices that may not have dedicated administrative staff.
Limited negotiating power: Providers may have limited negotiating power when it comes to healthcare contracts, particularly if they are small or independent practices. This can make it difficult to secure favorable terms or negotiate higher reimbursement rates.
Major Pain Points With Credentialing
A lengthy and time-consuming process that requires significant time and effort from providers. This can be particularly challenging for new providers or those who are changing practice locations or affiliations.
Complex requirements: Credentialing requirements can vary widely depending on the payer and the provider’s specialty. Providers may need to provide a range of documentation, including educational transcripts, training certifications, malpractice insurance, and more.
Multiple credentialing sources: Providers may need to be credentialed by multiple sources, including insurance companies, hospitals, and other healthcare organizations. Each source may have different requirements and processes, which can add to the complexity and time required for credentialing.
Re-credentialing requirements: Providers may need to be re-credentialed periodically, which can be a time-consuming and resource-intensive process. This can be particularly challenging for providers who are managing a busy practice.
Inconsistencies and errors: There may be inconsistencies or errors in the credentialing process that can lead to delays or rejections. This can be frustrating for providers who may need to resubmit documentation or follow up with credentialing sources to resolve issues.
“HealthPro RCM took the stress of medical billing away from my practice and I couldn’t be happier “