Three Things to Look For When Credentialing a Group Practice
Credentialing a group practice is more complex than credentialing individual providers. Ensuring that every member of your team is properly credentialed, contracts are appropriately negotiated, and timelines are managed efficiently is crucial to running a successful mental health practice. If your group’s credentialing is mismanaged, it can result in significant financial losses, delays in reimbursements, and compliance issues. Here are three critical aspects to consider when credentialing a group practice:
1. Consistency in Provider Information and Documentation
The foundation of any successful credentialing process lies in accurate and consistent provider documentation. For group practices, this becomes even more crucial as you are dealing with multiple providers. Each therapist, counselor, or mental health professional in your group must have their credentials up to date and consistent across all documents. These include licenses, certifications, educational background, and professional liability insurance.
Inconsistent or outdated information can lead to delays or denials in credentialing, causing disruptions in the revenue cycle. For example, if one provider's license renewal is missed or if their documentation differs from what’s submitted to insurance payers, your group could face a halt in reimbursements for their services. This becomes even more complex when dealing with multiple insurance panels.
An effective way to ensure all providers’ credentials are consistently maintained is by implementing a centralized credentialing system. This system should track important dates such as license renewals, continuing education requirements, and other time-sensitive documents. Without a streamlined process, managing credentialing for each provider becomes chaotic, particularly in larger practices.
Pro Tip: Practice Solutions offers Professional Services that can audit your credentialing system, ensuring that all provider documents are properly organized and up to date. This reduces the risk of missing key deadlines and keeps your practice running smoothly. For more information on how credentialing impacts revenue, check out our blog on how credentialing relates to billing which explains how credentialing delays can affect your revenue cycle.
2. Negotiating Favorable Group Contracts
One of the major benefits of being a group practice is the ability to negotiate contracts that work to your advantage. When you credential as a group rather than as individual providers, you can often secure more favorable reimbursement rates and terms with insurance companies. However, negotiating group contracts requires a deep understanding of what each provider in your practice brings to the table and how to present that to insurers in the most effective way.
Insurance companies may offer different rates for different types of services provided by various therapists in your practice. For example, a psychologist with a specialty in trauma therapy might command a higher reimbursement rate than a general mental health counselor. It’s essential to understand the specialties within your group practice and use them as leverage during contract negotiations.
When negotiating with payers, look beyond just the reimbursement rates. Consider aspects such as claims submission timelines, performance-based incentives, and the ability to add new providers to the contract without a lengthy re-credentialing process. Ensuring that your group contract is flexible and beneficial to your practice’s long-term goals will save you from administrative headaches in the future.
Pro Tip: Practice Solutions professional services can prepare you for negotiating contracts for group practices to ensure you’re getting the best rates and terms possible. We provide educational resources in contract analysis and negotiation strategies. For tips on negotiating insurance rates, read our blog series on renegotiating rates.
3. Managing Re-Credentialing and Maintaining Compliance
Credentialing is not a one-and-done task. Re-credentialing and maintaining compliance are ongoing responsibilities, and in a group practice, the complexity only grows as more providers are added. Most insurance panels require providers to be re-credentialed every two to three years, which involves updating all previous documentation and verifying that providers are still in good standing.
For group practices, it’s essential to establish a clear timeline for re-credentialing each provider. This timeline should include deadlines for document submission, insurance payer updates, and internal reviews. Missing re-credentialing deadlines can lead to temporary lapses in in-network status, which would prevent you from getting reimbursed for services rendered during the lapse.
Additionally, compliance with payer requirements is a critical part of the credentialing process. Insurance companies regularly update their credentialing standards, and failure to comply with these changes could result in denials or, worse, the termination of your contract. Staying up-to-date on the latest payer policies is crucial for maintaining a steady revenue stream.
Pro Tip: Practice Solutions billers can help ensure your group practice remains compliant with payer policies and re-credentialing timelines by providing reminders and guidance. Our Professional Services can also help you implement best practices for maintaining credentialing documentation and processes, reducing the risk of lapses in coverage and payment delays.
How to Effectively Manage Credentialing a Group Practice
Credentialing is a critical part of running a successful group mental health practice, but it’s also one of the most complex and time-consuming tasks. Ensuring provider documentation is consistent, negotiating favorable group contracts, and managing ongoing re-credentialing and compliance are all vital to maintaining a healthy practice, and clear and consistent processes are how to achieve these goals.
If credentialing feels overwhelming, or like a blind spot preventing you from achieving practice growth, Practice Solutions Professional Services may be your solution! We start by examining your practice thoroughly and identifying areas where processes are going well, need some improvement, or are missing entirely. From there, you can use the evaluation as a roadmap to implement or improve processes, or you can choose to purchase our resources developed specifically to help providers succeed and grow.
Our team can ensure your credentialing processes (among others!) are streamlined, organized, and fully compliant, allowing you to focus on delivering quality care to your clients. Reach out to us today to learn more!
