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Getting Credentialed
 by Jordan R. Stewart, DPM Timonium Foot and Ankle Center Established July 2006 Timonium, MD One of the challenges you will face when you open a new practice is that you're not immediately credentialed with the insurance carriers. When patients contact your office, they expect that all services will be billed through the insurance carrier. No matter how early you start, you will not be on all the plans right away. With that said, get started as soon as possible, but be prepared for delays, most of which will be resolved sooner or later. For credentialing with the insurance companies and hospitals, you will need to acquire certain licenses. Contact your state board of podiatry to apply for your state medical license and controlled dangerous substance license. Application for a DEA number can be completed online at the Office for Diversion Control website. Remember to make all transactions in the business name and under the business tax id. Besides licenses, you will need malpractice coverage. At the recommendation of several colleagues, I contacted the Podiatry Insurance Company of America (PICA). I was accepted for coverage through PICA several months prior to starting practice, but did not want to bind coverage until I actually started seeing patients. Insurance carriers and hospitals require a certificate of malpractice insurance for credentialing. PICA would only issue me a certificate of insurance within 60 days of binding coverage. I planned to bind coverage on July 1st, but this would not allow me to submit my insurance and hospital applications until May 1st. It takes longer than 60 days to get credentialed with most of the insurance companies. In order to get credentialed as quickly as possible, I had my representative at PICA draft a letter stating that I was approved for coverage as of July 1, 2006 and that my certificate of insurance would be forwarded once issued. This letter helped the credentialing process get moving. The redundancy of the credentialing process has been lessened by the Council for Affordable Quality Healthcare (CAQH). CAQH has an online application that stores and posts your information for the insurance carriers to download for credentialing. Applications for Medicare and Medicare durable medical equipment (DME) can be downloaded from the CMS website. There are several applications for Medicare enrollment. Contact your local carrier and describe your entity so you fill out the appropriate forms. Be aware that you cannot apply for a Medicare DME number until you start seeing patients in your facility. I found this out the hard way because my application was submitted before I opened. I had to resubmit the application when I opened the office leading to further delay. Getting credentialed is one of the most frustrating parts of starting your own practice. While you are waiting to get on the plans, make your patients aware of the situation and check their out-of-network benefits. In order to retain patients, you may need to reduce your fees until you are on their plans. Certain carriers allow you to request retroactive participation status once your application has been submitted. I was able to see Medicare and Bluecross patients and retroactively bill for the services once I received my provider numbers. Each carrier has their own policies so you will have to find out how this is handled. Be sure to get all approvals for retroactive billing in writing.
In the beginning it will seem to take forever to
get on the plans. Be prepared for mistakes and delays as I guarantee
they will happen. You will eventually get on the plans and then you
face the challenge of medical billing.
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