Managing Credential Renewals

Health care practice administrators often receive frustrating communications from insurance companies. The last-minute requests for credentialing renewals can be especially upsetting because of the amount of information you must submit. The easiest way to handle credential renewals and recertifications is to be proactive rather than reactive. Consider the following six tips to manage your credential renewals with ease.

  1. Create a System

Do not rely on memory. Creating a system of organization and reminders will also be important if something should happen to you. Credentialing is too important to risk a practitioner losing the right to bill because you came down with the flu.

Insurance companies are notorious for last-minute or late notifications. They may even blame the oversight on you. With a system in place, you have the luxury of working on your own timeline instead of theirs.

  1. Use a Spreadsheet

Create a spreadsheet to track the following about each practitioner in your practice:

  • Date of hire
  • Expiration date of license
  • Medicare certification date
  • Certification dates for each insurance network
  • Certification dates for major payers
  1. Ask About the Process

Contact each entity that requires recertification or renewal and inquire about its process, required documents, and submission deadlines. Add the deadlines to the spreadsheet. Next, pick a date 30 days out for each deadline and mark your calendar with a reminder to gather and submit the necessary documents.

  1. Gather the Documents

Don’t wait until the last minute to chase after your practitioners for their documents. Create a file for each practitioner with the documents needed for their renewals. The most common documents needed are:

  • Current CV/resume
  • Practicing license
  • Current liability/malpractice insurance
  • Application form for each payer
  • National Provider Identifier
  1. Keep Good Records

Each entity has its own transmission process, so keep meticulous records. For example, if the documents are to be faxed, keep the fax confirmation sheet provided by the fax machine. Keep the confirmation with the documents sent and mark your calendar with a reminder to call and confirm receipt of the fax transmission. If the information needs to be faxed a second (or third) time, transmit the fax confirmation sheets with each subsequent fax.

Remember, you’re not done until you’ve received the renewal. Continue to follow up until you have written confirmation the process has been successfully completed.

  1. Attend to Medicare Verification

Occasionally, a provider will disappear from the Medicare system without explanation. These mysterious omissions need to be corrected right away. There is great potential for lost billing revenue if this happens and isn’t caught in time.

Best practice is to regularly log into the Provider Enrollment, Chain and Ownership System to confirm each of your providers is still properly enrolled. Mark your calendar with a recurring appointment to perform this check.

An experienced healthcare law attorney can be a trusted adviser on credentialing renewals and can represent the physicians in your practice with compliance and licensing matters

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