As someone who has worked in various roles within the medical field for the past 15 years, I have gained valuable insight into the common mistakes made by medical practice owners when managing their businesses. To help prevent others from repeating these mistakes, I have created this channel aimed at assisting medical practice owners. My ultimate goal is to promote the growth and success of private practice medicine. In my view, the medical industry has become overly institutionalized, resulting in unnecessary challenges and demands. By sharing helpful videos, I hope to contribute to the resurgence of traditional, private-practice medicine.
I am the Owner/Administrator of a BHRF in Arizona. We’re not able to apply for an AHCCCS provider number, the States public healthcare plan, because of a moratorium on new providers. This has greatly hampered our efforts to fully open and accept residents into our facility. The only option we have is to target cash payers. How can applying in CAQH database help us in finding billable residents/clients to prevent closing of the business? Does our BHP need to be in the CAQH database for insurance companies to refer residents to our facility?
Hi there and thank you for watching. I’m sorry to hear of the struggles you’re experiencing. CAQH is used by insurance companies when getting providers credentialed. Not all companies use it. To be referred by an insurance company to your business, you first need to be contracted as an organization with each insurance company and then they will put your providers and group in their online directory under your specialty and address. For other referrals from colleagues, you would need to market yourself to other groups in your area so they know about you and your services. Good luck!
One of my providers ready to renew their DEA license (Calif) received this: Where can the training be obtained? On-line, on-site at selected facilities? "On December 29, 2022, the Consolidated Appropriations Act of 2023 enacted a new one-time, eight-hour training requirement for all Drug Enforcement Administration (DEA)-registered practitioners on the treatment and management of patients with opioid or other substance use disorders. Beginning on June 27, 2023, practitioners will be required to check a box on their online DEA registration form--regardless of whether a registrant is completing their initial registration application or renewing their registration--affirming that they have completed the new training requirement."
Hi there and thank you for watching. You can find multiple places that offer the new required training for free. If he belongs to the AMA/OMA or to your local state medical association they should have that available to him. I recommend Googling “free required DEA training course” to find one if he doesn’t belong to any of the associations mentioned above. Many will also provide CEU/CMEs for taking the course as well. Good luck!
I hope this helped ease the panic! I also offer a 3-part Credentialing and Contracting course and you can find it here navigatingthebusinessofmedicine.thinkific.com/courses/healthcare-credentialing-and-contracting Thank you for your support and Good luck!
I cannot find the link to access the Excel and PDF files mentioned in the last part of the video. Could you please provide the link to download the Excel sheet or the PDF?
I've learned how to get credentialed with BCBS, Cigna, Aetna, and UHC. However I am learning that Medicare is a beast of its own. Interested in taking a course.
Hi there! Great job on what you’ve done so far. Medicare is really not that difficult if you know the steps. Unfortunately my course does not go into step-by-step for Medicare. The first step is getting permission in the I&A portal to work on behalf of the group and providers you need to credential/reassign for Medicare. You need to create your own log-in to access I&A. There are instructions on that website that to help you. When completed and you’re a user, you need to make sure they grant you permissions in PECOS specifically when they authorize you under their own accounts. Your credentials work in I&A, NPPES and PECOS (Medicare). Good luck!
Hello. Currently I am living outside of America and doing only telehealth. Many patients asks me to ship the their medication (cheaper than buy inside the US). What should be the right license for me so I can ship controlled substances?
Hi Doctor and thank you for watching. Unfortunately, I am not aware if this is possible or where to look for that information since technically (my understanding is) it is “illegal” for patients to import medications from outside the country with the exception of a few circumstances. I’m sorry I can’t offer further assistance.
Thanks for the Video. I started contracting last year. The one thing I get is to keep on approaching the payer if they say they are willing to provide some raise. I have a question. If the contracting rep sometimes shuts you down and doesn't respond to your email. Is there a way to reach the supervisor? As I have very difficulty reaching out to Aetna's Contracting Rep.
Hi there and thank you for watching! Aetna, in my experience, has also been a challenging insurance to escalate issues. I’ve been known to call their claims department, or another department and ask for a supervisor. I have also asked to see if they have an alternative contact method or email address/phone number to try. I can’t say I’ve always been successful but I do try other avenues to see if someone can help get me there. I’m sorry you’re experiencing that, but you’re not alone. Good luck!
@@navigatingthebusinessofmed8251 ok. I will see what I can do. Actually, I have a successful negotiation on few of CPTs and the rep said that she was building the contract and now she is not responding. This was happening from last 3 months. I hope I can get a response. Thanks for your prompt response. Really appreciate your help.
Thank you for inquiring, but at this time I am focusing on consulting for medical practices only. I do offer a credentialing course to train people about the Credentialing and contracting process and that may help you. The link is in the video description and there is a QR code to scan in the beginning of many of my newer videos too. Good luck!
I was recently awarded my “Provisional-Active” license which will become an “Active” status is about a week. During the provisional Active status, do I qualify for applying for DEA certification? Or should I wait until it just reads “Active”?
It really depends on if you’ll be prescribing a lot of controlled medications or not and the state you work. Since DEA registrations are ran state to state, yours may have different requirements for the provisional license. Your local medical board should be able to provide more information for you to determine what is best for your situation. Thanks for watching!
Thank you for your question. Yes, I do offer consulting services. Please email me directly at jennifer@icsolns.net. I appreciate you watching my videos!
Given these challenges when it comes to claim denials/delays how can a practice that is either just getting started or has been in business for a while create predictable month to month cash flow?
Hi there and thanks for watching! This can be challenging depending on your payer mix and also your specialty. A good goal is to have a set number of “preventive” type visits each month as those tend to not go to patient responsibility and insurance pays. Of course, the patient would need to be due for such services per their plan benefits and based on the last time they had a similar visit or are age appropriate. More than anything, sending out clean claims the first time and following your payer guidelines is going to be key to successful cash flow in the practice. This also means checking patient’s benefits and eligibility before patients are seen too. This will ensure you’re participating with their insurance and you can collect any copays at time of service. If you choose to do a deposit for patients with high-deductible plans, this allows for some financial stability too. Practices just need to have very rigid guidelines and check payer contracts that it is okay to that for their beneficiaries. I hope this helps- I could talk all day on this and I think I found a topic for a future video! Thanks so much!!
@@navigatingthebusinessofmed8251 Thank you! Does this apply to the traditional fee for service environment or would this apply just as equally under a value based care bundled payment option ?
@@Anubis0680 this would mostly be for FFS model since quantity plays a major factor. However, coding and submitting clean claims still apply for both VBC and FFS. VBC sees more bundling of services for set fees so this would make it a bit easier to have goals and anticipate monthly income.
This topic is so multifaceted and you've covered it so well! Thank you for this and for all of your sessions. I've been a bit quieter of late as I'd moved on from my last role but now I'm back over in a new part of the medical field: DME, and at a nonprofit! The burnout there has been real as well. I'd love for us as a culture to really revamp our views on how we see ourselves as contributors to our greater world, but especially our local area.
It’s so nice to hear from you! I definitely noticed your absence. I’m excited to hear about your new adventure. DME is a whole other world of medicine and hoops to jump through, especially for Medicare. You’ll learn a lot and be great, I’m sure! Thank you for continued support and kind comments. I appreciate your insights.
Hi and thank you for watching my channel. I have a whole playlist centered around Credentialing and contracting with specific Medicare and Medicaid ones. If you are already an established group with payer contracts, you will need to check with your contracts and/or payer portals on how each require you to add a provider to your group contract. For Medicare, you need to reassign them on the PECOS website. The Texas Medicaid site should tell you how to add a provider. Every insurance will check to see if the provider is correctly credentialed and if they are due for re-credentialing before they add them to your group. They will let you know if they need anything else done in the credentialing realm of things. It is important to note that every insurance gives an effective date of when the provider becomes affiliated with the group and you cannot bill out services under that provider until you receive those effective dates and it is after that date or it will either process as out of network or deny if the patient does not have out of network benefits. I hope this helps! Good luck!
Hi there! Your new practice/business will need to be recognized by both Medicare and Medicaid to be considered in-network, even if you plan on billing as a sole proprietor. You will be affiliated to the group as the owner, so if you’re due for recredentialing then they will tell you. I hope this helps and good luck!
Thank you for the information. Do you know what is an appropriate physical address to use when I apply for Medicare credentialing since my practice will be mobile service and I am a nurse practitioner in FL?
Hi and thank you for watching! Since you’re going to be doing mobile service and not have a brick and mortar building to see patients, they will accept your home address. You can also call your Medicare Administrator Contractor (MAC) to ask while completing the application as well. Good luck!
Hi there and thank you for watching. Yes, usually the application asks for a director to oversee the lab. Usually the owner provider or Medical Director of the practice is listed. Good luck and I appreciate the support!
Thank you for this helpful video! If there are two owners for the same practice does each need to get an npi 2 or can one provider apply for the npi2 and the other add to their profile ?
Hi there and thanks for watching! The NPI 2 is only for the organization/business itself, not per provider or owner. This will be used on all providers who work at the practice when the information asks for the group information (usually NPI 2 and EIN). I hope this helps!
Hi Jennifer, thank you for the great information and thanks a million for sharing your knowledge💜💜I am going to take your course in a couple of weeks. Is it one price for both courses? Or two separate prices for the course? 😊
You are so welcome and thank you for your support and kind words! My entire course is broken into three separate sections, I just released the last section on Friday. They are all individually priced so that people can take them at their own pace and when they can afford them. Good luck and thanks so much again!!
My state allows a designer instead of an architect to create the formal drawings if the space is under 5000 ft.². My general contractor, who I trust, recommend this option to save money. Is this OK or should hire an architect?
Hi there and thank you for watching. It really depends on what kind of changes you are making. If there are a lot of major structural changes then an architect would probably be a good idea, or if you have to get permits approved by a municipality and they require architect vetting then you should. If you’re keeping things similar to what is existing then a designer may suffice. In my experience I’ve always worked with architects who specialize in medical practices and never a designer. If you trust your general contractor then you can always go that route first. Good luck!
Thank you for watching. Unfortunately it’s not as simple as just knowing terms. I have multiple videos on this topic and a credentialing course that should assist learning more. Good luck!
Hi there and thank you for asking! I have been an administrator in both primary care and specialty, but all have been private practices. The specialty group I worked was multiple locations in 4 different states.
If you have received an EOB from the insurance then that means you have already received services. I would recommend calling the practice to ask if they offer any assistance for will work with you to pay your portion of the bill. In the future I would try to find out the cost of services ahead of time and check your benefits to get idea of how much you will need to pay. There are usually clinics in an area that may offer better discounts to people in certain financial situations so that is something to explore too. Good luck!
I am looking for someone that can help train my front desk staff on collecting co-pays, co-insurance and deductibles. I have a home health agency and 2 outpatient clinics.
Hi there! You should be able to use your NPI 2 with all insurances, including DME Medicare assuming you’re billing all insurances under same the same group. Thanks and good luck!
I own a small medical supply business selling to small physician offices and other healthcare facilities. I want to get into the DME space to start billing Medicare+Medicaid. We have incredible prices on products from large manufacturers. Hpow do I go about that?
Thank you for watching. You need to get contracted with insurances to become a recognized DME supplier. All insurances have their own requirements so you need to look up each insurance to find out their process. You can go onto CMS’ website for Medicare and use the PECOS portal. Here is a link to start your quest: www.cms.gov/medicare/enrollment-renewal/providers-suppliers/durable-medical-equipment-prosthetics-orthotics-supplies-dmepos. Personally, I have never done this but I do know there are specific requirements. Good luck and thank you again!
Thank you for watching and for the comment. I am not aware of insurance companies requiring specific platforms to be used, but I am aware they do require most platforms to have a special certification and that can be a way to require certain platforms to be used. I know they were very lenient about this fact during the Public health emergency of Covid but they have started reinforcing the rules since that ended last May. I always encourage checking each insurance companies, telehealth policies if you plan on billing for those services.
Hi and thank you for watching. I would suggest signing up for some type of customer feedback service where emails and text messages can be sent to patients after services are rendered to provide feedback and then have it linked to your website. There are many options out there - just Google “Patient Survey Tools” to find some, but also don’t forget to ask your EMR company if they offer something similar too. Good luck!
Hi there! I’ve never been through the process with a provider, but my understanding is if you have waited the required amount of time you were told when it got revoked or you surrendered it then you can reapply for a reconsideration online. I suggest checking the website and call the Customer Service number if you have further questions. Good luck!
