5 common Physical Therapy credentialing issues and how to avoid them

One of the reasons our physical therapy billing is so successful is that we go to great lengths to verify provider credentialing when we onboard a new client. It’s a win-win for us and our clients when their billing goes out of RevFlow right the first time. Many times when we are southing through a new practice’s credentialing we find errors and inconsistencies that the owners and PT office manager weren’t even aware of. We see this a lot when a practice has gone through growth or some other transition. Although change is typically positive for your business, if someone in your organization isn’t diligent and consistent about also updating your credentialing it can spell disaster for your bottom line.

When onboarding new clients, here are the top five credentialing issues we see:

  1. Practice address not on file
  2. Payment address not on file
  3. Legal name not on file with the insurance carrier
  4. Individual provider not lined to group
  5. Carriers not being notified when a location moves

Any one of these credentialing issues can cause major headaches including your claims to process incorrectly (out-of-network), payments sent to the wrong address, or payers (especially Medicare) holding payments until your credentialing is up to date.

If you think your PT practice may be guilty of one of these credentialing offenses and the thought of updating your credentialing makes your head spin, don’t panic. Here are some steps you can take in your physical therapy practice for successful credentialing:

  • Elect a Credentialing Coordinator
    • Whether you have the resources to outsource credentialing tasks or decide to handle them in house, assigning a credentialing coordinator to stay on top of deadlines and expirations is a good idea. He or she should stay on top of all the current forms or online application processes and make sure nobody’s credentialing or re-credentialing fall through the cracks so reimbursements aren’t delayed or denied for this reason.
  • Allow Plenty of Time
    • Many practices get started on the provider enrollment process simply too late, which can turn into a revenue nightmare. While credentialing “should” take around 90-days, you should really give yourself more like 150-days to complete the process (maybe longer if you make a few mistakes along the way.) Remember, credentialing with payers takes places on their terms and on their timeline. Always allow yourself ample time and hopefully you’ll be pleasantly surprised when it takes less them than you expected.
  • Be Complete and Consistent
    • Whether you are compiling data yourself or working with a credentialing company, checking the applications for completeness, accuracy, and consistency are essential. As you practice grows and you bring on new therapists, add or move locations, and sign new insurance contracts you must be consistent across the board with all of your credentialing. Inconsistencies with credentialing will delay the entire process or can delay or deny insurance payments.

The fact is physical therapist provider credentialing and enrollment is time consuming and at times can be perplexing to your PT office manager. If done haphazardly or delayed too long it will spell cash-flow problems, scheduling nightmares, and other scary thins that go bump in the night. If you have credentialing tips you’d like to share or have a specific question we’d love to hear from you. Send us an email at insights@bmsemail.com.

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