Physician Credential has become a fundamental part of Medical Billing and Revenue Cycle Management; as it helps Insurance carriers to ensure the providers meet the significant standards to ensure quality Medical Treatment and patient care. Physician credentialing also ensures that there is standardization with increased efficiency in patient care, thereby improving the business opportunity of Physicians and Medical Practices.
Medical Billing, Coding, and Physician Credentialing rules and updates are constantly updated and changed to meet the ongoing changes in the US Healthcare Industry, with such changes and updates, the physician credentialing process can become more cumbersome and laborious, however, having a checklist of documents to be submitted along with the Credentialing application and also having the CAQH and PECOS updated and keeping them current will avoid unwanted delays in Physician Credentialing Process.
Physician Credentialing Checklist:
- Updated Curriculum Vitae with a complete professional history in chronological order
- Credentialing Application duly filled accurately along with all supportive documents
- Educational and Medical Graduation Certifications
- Board Certifications
- Certification for Internship, Residency, etc.
- Current Medical License and State Licenses
- DEA Certifications
- Malpractice Insurance and Coverage details for 10 years
- CAQH Enrollment
- PECOS Login credentials
- W9, NPI, and CLIA certifications
- Driving License, Social Security Number
- Federal Tax ID and ECFMG Certificate Number
- CME activities for the past 3 years
- Work History with complete employment and affiliation details
- Explanation and supportive documents for career gaps if any
Listed above are basic documentation requirements for the Physician credentialing process, however, based on the type of insurance and the physician’s background the supportive documents required can be extensive, and delay the timeline to process the Credentialing Application. Therefore it is mandatory that the physician or the Credentialing team have a streamlined approach to avoid missing on any important documents or information and ensure smooth and faster processing of privileges.
The rules and updates for Physician Credentialing are often revised, with the recent novel COVID 19 and global pandemic attack, many extents in the US healthcare industry went through significant changes, In line with that, Medicare also imposed certain Provider enrollment changes and updates as listed below
- **Beginning January 1, 2022, CMS no longer requires enrolling Medicare Diabetes Prevention Program (MDPP) suppliers to pay the provider enrollment application fee.
- **Physicians, Non-Physician Practitioners (NPPs), physician organizations, and non-physician organizations don’t pay a Medicare enrollment application fee
- **Institutional providers and suppliers like Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers and Opioid Treatment Programs (OTPs) pay an application fee when enrolling, re-enrolling, revalidating, or adding a new practice location.
- **The 2022 enrollment application fee is $631.
- **The Medicare Enrollment Application Information webpage has more information.
Apart from the above updates on enrollment fee, Medicare and CMS has initiated Multifactor Authentication with PECOS (effective Jan 2022) and EMR (Effective April 2022). Additional starting July 2022, PECOS Scroll Functionality is activated to ensure the member reads and acknowledges certification terms and conditions before electronically submitting Medicare Enrollment Application.**
To know more about Physician Credentialing Process reach out to MGSI.
About MGSI
MGSI is a full-service Medical Billing and Revenue Cycle Management Company located in Tampa, FL. With over 25 years of expertise in the Healthcare Industry MGSI guarantees to reduce revenue loss due to delays in Physician Credentialing. MGSI has experience handling CAQH and PECOS Credentialing for all Government and Commercial Insurance carriers. To know more about MGSI and our services call 1-877-896-6474 or visit Medical Physicians and providers Credentialing Services | MGSI (mgsionline.com)
Healthcare Billing - Blogs 