I remember the call distinctly. I had just written an article for a publication titled “How to Negotiate Reimbursement Rates.” Dr. Jordan, a New York dermatologist, called and asked to speak with the author. I replied it was me, and he said, “I really need your help. I can’t survive under these reimbursement rates.” I let Dr. Jordan know I could absolutely help him and would need a few items before getting started. I begin explaining the process, and he stopped me in the middle and, in a strongly worded statement, said, “I need to meet with you immediately. In person.”
Inflation is affecting many businesses, but medical practices tend to see the brunt of its effects because of the way payment structures are dictated by insurance payers. Even more worrisome, practices have had to increase wages significantly and the current job market tends to favor employees. In some instances, employees are asking for wages 20-30% higher than previous, and understandably can command these wages as there is fierce competition for skilled employees. While these issues are affecting many businesses, there are things medical practices can do to help ease the squeezing margins.
What Is Credentialing?
Credentialing is the formal process of verifying a provider’s qualifications. This ensures that doctors and nurses have the proper training and experience to provide the highest level of care to patients. The provider credentialing process is completed by verifying all provider documents and ensuring that they are valid and current. Most health insurance companies will not even offer reimbursements if providers lack medical credentialing.
From the early stages of the COVID-19 pandemic, healthcare providers have been reaching out to us expressing some of the most difficult decisions they have ever been faced with; Practices are struggling to keep their doors open as costs mount, and revenue has fallen significantly. Practices are faced with temporarily shutting down or closing permanently, even the ones that have seen growth and success for years. Where should we all be looking to ensure practices remain open, implement the right changes, and evolve their operations for the future?