Everything You Ever Wanted to Know about Insurance Panels…

Healthcare may very well be the only industry in which the consumer does not pay directly for services. Instead, insurance companies and government payers are writing the checks, which makes them vitally important to the financial health of a practice.

Whether you are starting a new practice or you’ve been established for decades, navigating the credentialing process in order to be paid by a carrier requires attention, expertise and diligence. Here are a few tips for working with insurance panels:

• If you are starting a new practice, take everything.

“Don’t be choosy off the bat,” says Anthony J. Vuozzo, MPA, Practice Consultant at ECM. “Try to participate in as many panels as you can to get the money flowing so you can pay your bills.” You can always elect to drop carriers later if the reimbursement levels are inadequate. Bonus – on rare occasions, payers will negotiate a higher rate if you tell them you are leaving their network for financial reasons.

• Consider joining an Independent Practice Association (IPA)

“It can be difficult to negotiate favorable rates as an independent physician with a single location,” says Vuozzo. “But an IPA that has maybe 400 doctors will be able to get a better rate than you can get on your own.” Bonus – IPAs may be able to get you into a “closed” panel with a commercial insurer under their existing contract.

• Make sure your information is up-to-date

Insurance companies have streamlined the credentialing and recertification process by relying on the Council for Affordable Quality Healthcare (CAQH), which maintains a central database of on physician licensure, DEA certification, malpractice insurance, and more. Vuozzo emphasized that it is important for physicians to monitor their CAQH listings quarterly to ensure that the they are up-to-date. If your information appears to be expired, you could experience a delay in being reappointed.

• Work with a partner

“It is good to have somebody in your corner because things happen day to day,” Vuozzo said. “If you get a letter or an email from a carrier, it’s beneficial to have a partner who can investigate and solve problems for you.” ECM monitors CAQH listings as a complimentary service for all of its billing clients. Non-billing clients can also contract with ECM to provide credentialing and monitoring services.

• Don’t ignore Medicare

…or Medicaid, or Blue Cross or United. If you receive a message from a payer, respond promptly or have someone respond on your behalf. “Keep an eye on your mailbox and your email,” recommends Vuozzo. “If you are participating in Medicare, Medicaid or private insurance, and you don’t recertify when you are required to do so, you will be kicked out, and it can take months to become active again.”

• Keep learning

For tips and updates, follow ECM on Facebook and LinkedIn, visit our website, or give us a call at 516.775.8606 for a complimentary credentialing review.