Payor Credentialing

Delay Not! Don’t Allow A Credentialing Process Outside Of Your Control Hinder Your Start Date

 

“The patient billing and collection process is going smoothly during the pandemic, including billing for telehealth visits,” says Laurie Guagenti, Managing Partner of Premier Healthcare Services, a long-standing physician billing company in Illinois. “What HAS changed is the increased amount of time it takes to get physicians credentialed by payors.” Typically, physician employment contracts state that the physician must be credentialed by specific payors before providing any services. Consequently, due to the complex and time-consuming credentialing process and now short staffing by the payors, physicians should be careful to prevent delays in their start dates so they can predict when they will have an income.

 

We have received inquiries from clients as to what can be done from a legal perspective. As previously highlighted in one of our articles titled “I Did Not Have My Contract Reviewed by An Attorney Before I Signed It. Now I Need to Pull A Rabbit Out of My Hat!," contracts should be reviewed and negotiated carefully before the terms of any employment offer are accepted.  Credentialing is not within the control of the physician once he/she has complied with information requirements which normally include providing the requested information to the employer or payor in a timely manner. Therefore, when it comes to the language about the credentialing process in an employment agreement, we recommend adding a “no later than” date to clearly indicate that the credentialing process must be completed by a specific date.

Be prepared that future employers may balk at stating a definite start date because, understandably, they want an employed physician to start seeing patients immediately after starting and, of course, they want to receive payment for the services provided by the physician. In view of the pandemic, if a physician wants to negotiate a “no later than” date for the contract, one suggestion is to offer the employer other services that would not constitute “treating patients.” For example, reviewing medical records or policies and procedures are tasks that can be performed by a physician and that do not require directly treating patients.

As always, we are here to assist you in negotiating employment contracts and to guide you every step of the way!

For further information, please Contact Us.

Articles distributed by Malecki & Brooks Law Group, LLC are advertisements and summaries for general information and discussion purposes only.  They are not full analyses of the matters presented, legal, or otherwise, and may not be relied upon as legal advice. 


 

 

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