Credentialing & Contracting

Credentialing is Critical

Credentialing of your providers is much more than just including them in the various payors/carriers/administrators. Initial and ongoing credentialing is critical to ensuring compliance in all aspects of the process and you, and your practice, remaining compliant with the various governmental entities. 

With MPS Credentialing:

  • All licenses are primary source verified.
  • Alignment with the proper governmental agencies to ensure compliant participation.
  • Core files created for each provider containing all needed information is readily available.
  • Monthly reporting.
  • Initial and ongoing queries of the necessary governmental agencies.
  • Ongoing monitoring of licenses/certifications/ certificates/etc. to ensure expiration dates are not exceeded.
  • Various agencies attestation requirements are met to remain in compliance.

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Contracting is Complex

Contracting with managed care organizations (MCO) is more complex than focusing on the reimbursement rate. The language of the contract is often not thoroughly reviewed. Provisions in the contract may create unnecessary burdens for the provider.

MPS CONTRACTING PROVIDES:

  • Resources to identify and define leverage to enhance positioning for negotiations.
  • Proactive review of each contract, alerting the provider of recommendations for revisions prior to renewal.
  • Negotiate contract language and reimbursement rates, as defined by the business strategy and approved by the client.
  • Prepare and maintain a core file with matrix(es) of contracts with a quick reference of key terms and reimbursement rate compared to the benchmark rate.
  • Maintain payer relationships and initiate any contracting discussions.

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Man

Jason Junkins, MD

Changing to a new billing company is a big decision for any medical practice. With the change comes many uncertainties and it is a huge leap of faith. If not maneuvered with skill, the change can have disastrous consequences on cash. With Medical Practice Success, you not only have the benefit of a highly skilled team of experts, but you also have a true partner in every sense of the word.

Stacy and the MPS team partnered with my multi-location practice while we were changing EMR/practice management systems and opening another clinic. The transition could not have been better. This huge challenge was met with professionalism and tenacity which I have not seen with any other group I have worked with. When an issue arose, Stacy and her team were our advocates to payers and proactive in addressing an issue with a payer. I could not be more pleased with my decision to partner with MPS.

Jason Junkins, MD Southern Immediate Care

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