Credentialing, Contracting and Billing……
What is the REAL difference between them AND the connection?
Over the last 30 to 35 years, the medical industry has looked, reviewed, hammered and just about beaten these three medically necessary job tasks to death.
All arguments have pointed that they are the same, do the same, work the same and act the same. However, as Medical Staff Professionals (MSPs) say, if it walks like a duck and quacks like a duck, then it must be a DUCK! The same can be said about Credentialing, Contracting and Billing!
Yes, it could be said that ONE person could have handled all three tasks about 30 to 35 years ago, because the rules were simple. In this day and age, however, the playing field has changed, and the rules are no longer simple. These three specific job tasks have evolved over the years and have proven to be more complex when compared to one another with which ONE person can no longer maintain and keep up.
Many individual practices, group practices and practice management firms have failed to realize that these are separate functions that need special attention respectively and should not attempt to combine them or employ shortcuts just to say, “It is to keep costs down”. Each one of these functions in the medical practice needs to have specialized procedures and appropriately trained staff to meet these tasks. Those individuals are the ones that “THINK OUTSIDE THE BOX”, know what to do and what not to do in a moment of chaos or crisis.
Many such medical practice entities and/or firms have either forgotten or do not realize that Credentialing, Contracting and Billing has evolved from just signing a piece of paper, completing a two-page application or putting codes and numbers into a medical billing system to be paid for their services. It is much more than that, and it will continue to evolve more and more each second, minute, hour, day, week and year as time goes by.
Credentialing goes well beyond the verifications of medical providers, just as Contracting goes well beyond networking or as to Billing goes well beyond data entry and payments. They all encompass unique responsibilities to produce the necessary path to true gain and revenue for the medical providers that service their patients. Without these three job tasks, a medical provider is doomed to fail - no matter how many times you say it or think it, each task carriers a considerable amount of responsibility to its own credit.
With this in mind, ICD-10 is just a few days away from being the next biggest thing since the signing and creation of Medicare. We owe it to ourselves as MSPs must to continue to educate our providers / employers of what we do, and the differences between Credentialing, Contracting and Billing as functions of the industry.
Keep on fighting the good fight, and remember that we, as MSPs, protect and service!
Thank you
Orin Price
Owner - Credential That LLC - www.credentialthatllc.com