Credentialing 101

Setting up private practice billing can be an intimidating process, especially if you aren’t sure where to start. The first step of the process is always credentialing with insurance companies so that you will appear on their website, in their brochures and in their patient information booklets as a qualified provider. 

Why is Credentialing Important?

If you are not credentialed with a certain insurance provider, you will need to bill the company as an out-of-network provider. Many times, insurance companies will deny these claims and the patient will be stuck with the bill. Most government-based insurance companies like Medicaid, Tricare and Medicare will not pay for any out-of-network services. Practices without credentials will not be able to attract as many patients and might lose patients due to steep out-of-network bills. 

The Basics of Credentialing

The credentialing process typically takes from 90-120 days. Before you get started, make sure that you have the following in place:

  • A separate tax ID number for your practice
  • Malpractice insurance
  • An NPI number
  • A state license for the state you are operating in
  • Knowledge of your taxonomy code if you plan on treating Medicare and Medicaid patients
  • A profile on CAQH.org, a very common credentialing database that most major insurance companies look at
  • A practice location and address

When you are ready to begin the credentialing process reach out to Vetters Enterprises for assistance in managing all the nitty gritty details, or start by contacting the insurance companies that you want to be credentialed with to get applications. Always review contracts before you sign them so that you are familiar with the documentation standards, claim submission standards, appeals processes, free schedules, CPT codes and diagnosis codes. Once you are an approved and credentialed provider with an insurance company, you will gain access to their online provider website. Online tools are a great way to keep track of claims and appeals as they occur.

Need More Assistance?

There’s no denying that the credentialing period is a daunting and lengthy one, which is why Vetters Enterprises is here to help! Looking for a way that your practice can alleviate the stress of having to go it alone? At Vetters Enterprises, we’ll manage everything and take care of all the nitty gritty details during your credentialing period, so that you can get back to what is most important – taking care of your patients.

Vetters Enterprises specializes in practice management, revenue cycle optimization and private practice business support. We can also perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

Losing Sleep? Fibromyalgia Might Be the Culprit

Many people suffering from fibromyalgia often suffer from sleep disorders as a result of their pain and discomfort. However, recent studies have shown that treating the sleep disorder can help to alleviate daytime fibromyalgia symptoms. How are sleep and fibromyalgia related? What can you do to help relieve your symptoms?

Sleep Disorders

A whopping 75% of those with fibromyalgia also suffer from sleep problems. The most common issue reported is tiredness immediately after waking. Insomnia, or not being able to sleep, is also very common in those with fibromyalgia. Overall, patients with fibromyalgia often have the following sleep issues:

  • Lighter sleep
  • Less time in deep stages of sleep, like REM sleep
  • More time awake in between periods of sleep
  • Insomnia
  • Restless leg syndrome
  • Sleep apnea
  • Upper airway resistance syndrome (a special type of sleep apnea)

Improving Your Sleep

If you have fibromyalgia and struggle with sleep, there are many ways that you can try to improve the quality and quantity of your sleep. Some of the best ways to improve your slumber include:

  • Determine how much you should be sleeping and only sleep that length of time
  • Keep a journal next to your bed to record how long you slept, what time you went to bed and woke up, and the quality of your sleep
  • Wake up at the same time every day
  • Try different relaxation techniques like massage, deep breathing or listening to white noise
  • Exercise earlier in the day to tire yourself out
  • Don’t nap during the day
  • Keep your bedroom temperature cool and comfortable
  • Don’t drink caffeine or alcohol before heading to bed

Keep Your Patients and Your Practice Healthy

Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

Stop Type 2 Diabetes in Its Tracks!

Type 2 diabetes is one of the most pressing diseases currently affecting Americans. While type 2 diabetes was traditionally most prevalent in older adults, it is now becoming very common among young adults and even children. Many people don’t realize the harmful effects of type 2 diabetes until it’s too late. How does type 2 diabetes affect life expectancies and how can you prevent yourself from getting it?

Type 2 Diabetes and Your Life

Diabetes is currently the 7th most common cause of death in the United States of America. While there isn’t currently an accurate average life expectancy for adults with type 2 diabetes, it is widely accepted that it dramatically decreases your lifespan. The more your type 2 diabetes is under control, the longer that you will live. If your type 2 diabetes goes undiagnosed or untreated for long stretches of time, it will definitely cut into your normal life expectancy. The most common killer of people with type 2 diabetes is heart disease. Over time, high blood sugar will damage your blood vessels and lead to cardiovascular disease.

Prevent Type 2 Diabetes

Thankfully, there are many different ways to decrease your chances of developing type 2 diabetes.

  • Reduce your portion sizes during meals and add more fruits and vegetables to your plate.
  • Exercise for at least 30 minutes a day 5 days a week.
  • Move when you don’t need to! Try walking to the post office instead of driving, or walking to a coworker’s desk instead of sending an email.
  • Make healthy food choices at least 80% of the time.
  • Drink water instead of caffeinated beverages or sugary sodas.
  • Track the food and drinks you consume every day to spot patterns in your eating or binging.
  • Take your blood sugar regularly if you are concerned about your risk for type 2 diabetes.

Keep Your Patients and Your Practice Healthy

Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

Global Billing for Maternity Care

Many expecting mothers don’t realize that their visits to the doctor aren’t going to be billed the way that they have previously (one by one). Instead, maternity care is billed globally, beginning with the date of the visit where your pregnancy was verified.

 

 

 

 

 

Global Billing 101

Global billing is used when the same doctor or doctor’s office will be providing all of your maternity care including at least 3 visits before pregnancy, delivery and postpartum care. Some patients may have many more than 3 visits before birth, depending on how high-risk their pregnancy is. Postpartum care is typically defined as a period of 56 days after a vaginal delivery and 90 days after a cesarean. Global maternity billing takes the entire deductible for the course of the pregnancy period and splits it into even payments over the course of the period. The doctor’s office that takes care of you throughout your pregnancy will submit one bill to your insurance at the end of your maternity care and submit your payments on your behalf.

What Does Global Maternity Billing Include?

Depending on your insurance, the details might vary. However, the following are
typically covered by global maternity billing:
• Prenatal visits, including medical history or physical exams
• Urinalysis to confirm the pregnancy
• Labor and delivery fees
• Evaluation of the newborn baby
• Episiotomy
• Postpartum care through 6 weeks
• Postpartum pap smear
• Placenta delivery

If you are a doctor’s office or practice using global maternity billing, Vetters Enterprises
can help you streamline your facility’s systems to see where you can further reduce costs
and increase efficiency. Vetters Enterprises specializes in practice management, revenue
cycle optimization, and private practice business support. We can perform detailed
assessments of your practice or facility and identify potential issues. Let us keep your
business as healthy as you keep your patients! Give us a call at (443) 352-0088.

Utilizing Rock Steady Boxing to Combat the Impact of Parkinson’s Disease

It’s no secret that exercise is a critical aspect of maintaining overall health. For patients with Parkinson’s disease (PD), a regimen that includes boxing may spell more relief than ever. The signs and symptoms of PD may include tremors, slowed movement, rigid muscles, impaired posture and balance, loss of automatic movements, and changes in speech and writing abilities.

Of all the pills I’ve taken, Rock Steady Boxing is the finest and most effective.”– Pete Stewart

 
 
 
 

A Medical Breakthrough That’s Knocking Out Parkinson’s Symptoms

Rock Steady Boxing, a boxing program designed with Parkinson’s patients in mind, is a medical breakthrough in terms of targeting symptoms specific to the diagnosis. Boxing tests balance, agility and hand-eye coordination, which can all be impacted by PD. Utilizing a “whole body approach,” the program encompasses not only boxing, but squat jumps, heel walking, agility drills, raised-knee walking, trampoline work, jumping rope and skipping. There are:

  • 60,000 people diagnosed with Parkinson’s disease annually
  • 360 Rock Steady programs around the world (operating in 89 sites around the country)
  • 18,000 people training with the Rock Steady program

Rock Steady Boxing Results Inspire Hope in the Fight Together Against Parkinson’s

The professionals at Rock Steady promote the community aspect of the full-body workout, reminding patients that they are all “fighting together against Parkinson’s.” A 2011 study in the journal of the American Physical Therapy Association revealed that Parkinson’s patients who participated in two to three 90-minute Rock Steady training sessions per week for nine months found “short-term and long-term improvements in balance, gait, activities of daily living, and quality of life the boxing training program.”

Get Local with Rock Steady Boxing Charm City

Through her a passion for movement and dedication to the Baltimore community, Head Coach, Patty Wessels developed a plan to open a boxing gym for individuals with Parkinson’s Disease, in cooperation with Mind Body Physical Therapy. There is now a gym that functions solely as a boxing space at the Mind Body office, located at Coppermine Fieldhouse. Patty couldn’t be more thrilled to bring Rock Steady Boxing to Charm City!

How Boxing Helped One Man Get “Unstuck” In Response to His PD

The Washington Post reported on the Rock Steady program last year from the point of view of Dan Kiefer. The author stated, “Let’s be clear: Boxing, even when the opponent is only a heavy bag, is a brutal sport. But brutality is needed, even welcome, when you’re facing a progressive, incurable neurological disease. I have Parkinson’s disease, and it causes my body to just freeze up. Weirdly enough, boxing helps me get unstuck.” Kiefer credits Rock Steady’s goal-oriented training program with giving him the confidence to perform the regular, hands-on movements that come easily to those without PD (such as selecting an object from the grocery store shelf).

In this first-person account of his experience, Kiefer goes on to say, “So I pound away on the heavy bag, not training for a fight because I am already in the thick of one. It’s a fight for my life, and as long as there is no cure for Parkinson’s, the disease ultimately remains undefeated. But I and the other pugilists in my twice-weekly boxing class — all with the unmistakable tremors and awkward gaits of Parkinson’s disease — can at least make it an interesting, and maybe even fairer, contest.”

You can read Kiefer’s full story here and take a look at Rock Steady testimonials if you’d like more information about how current fighters are utilizing this method to maintain and improve their freedom of movement in response to PD.

Preventing Sciatica with Chiropractic Care

While there are several different reasons that a patient could experience short-term or chronic lower back pain, a pinched sciatic nerve is a common culprit. The sciatic nerve is the longest nerve in the body, and when it is compressed or irritated it can result in severe pain. Keep reading to learn more about chiropractic treatments and methods for preventing sciatica.

 

 

 

What is Sciatica?

Sciatica refers to a leg pain caused by a pinched nerve that originates in the lower back but can radiate into the back or side of the legs. Pain can vary in intensity from dull, achy pains similar to a toothache, to pins and needles that are comparable to electric shocks. As you can imagine, this can be incredibly hindering and downright intolerable for patients. In most cases, the pain of sciatica dissipates within 6-weeks when a specialized treatment plan is in place.

Chiropractic Treatment and Other Methods for Preventing Sciatica

While many disorders can cause sciatica, a herniated disk is commonly to blame. Patients experiencing sciatica tend to respond well to a combination of treatments that are specific to their symptoms and cause of pain.  Effective sciatica treatment plans for long-term relief often include:

  • Chiropractic Manipulation – Spinal adjustments are a non-invasive and drug-free option for relief. They can help relieve pressure on the sciatic nerve by freeing restricted movement of the spine and minimizing the nerve irritability that causes inflammation, pain and muscle spasms.
  • Exercises – Extra weight and lack of movement can put pressure on the spine and weaken the muscles, increasing the risk of further strain. Physical therapy, deep stretches and exercises that promote core strength in the back and abdomen, such as yoga, are helpful for relief.
  • Posture Practice – Eliminate poor posture by aligning the ears over the shoulders, shoulders with the hips, tucking in the buttocks and engaging an active core. When sleeping, it is helpful to put a pillow under the knees and avoid sleeping on the stomach.
  • TENS Unit – Transcutaneous electrical nerve stimulation (TENS) units minimize muscle spasms and treat acute pain through variable intensities of electrical current control.
  • Anti-Inflammatory Medications – NSAIDs, such as ibuprofen and naproxen, can relieve pain by reducing inflammation.

The Shift from Volume to Value: The Challenges

Now that we have covered the basics of volume-based reimbursement and value-based reimbursement and all of the wonderful benefits it will bring, we will address some of the anticipated challenges your healthcare facility might face.

In Case You Missed It

Healthcare providers are currently shifting from volume-based reimbursement plans to value-based reimbursement. This dramatic change is designed to benefit patients, healthcare providers and the payers. Value-based reimbursement promises to give patients the highest quality care for the lowest possible amount and shift the focus of healthcare providers to the actual health of their patients.

Medicare and Medicaid

As the baby boomer population grows older and more reliant on Medicare for their medical expenses, the reimbursements that healthcare facilities receive will decrease. In addition to the growth in Medicare patients, the use of Medicaid has also grown. The new mix of revenue will definitely take a toll on your office’s bottom line if you are not prepared.

Reconciling Volume-Based and Value-Based Payments

The next challenge healthcare providers face is reconciling the new value-based reimbursement model with your current fee-for-service environment. Tracking progress can be tricky, as you need to maintain detailed logging in two different payment systems at the same time. Your accounting systems and software might need a major upgrade in order to track value-based reimbursement patients, populations, and billing.

Keeping Track of Quality Measures

Most incentives for practices that meet certain value standards rely on keeping track of quality measures. You are probably already used to submitting some quality measures, but their effect on your bottom line might be new. The value-based reimbursement shift means that your ability to meet quality standards, benefit patients and cut costs is directly tied to whether or not you receive incentives or penalties.

This transition period is the perfect time to have an evaluation performed on your facility’s systems to see where you can further reduce costs and increase efficiency. Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

Changing Healthcare Reimbursement from Volume to Value

Healthcare providers are shifting from volume-based reimbursement to value-based reimbursement to benefit patients, providers and the payer. The goal of this dramatic shift is to provide patients with the highest quality care at the lowest cost to them.

Volume Based Reimbursement

Traditional healthcare used volume-based reimbursement or fee-for-service (FFS) mechanisms. Unfortunately, this model led to many healthcare providers feeling the need to over-treat, over-medicate and over-spend in order to make their ends meet. If healthcare facilities needed to earn more, they had to do so by treating more patients. Many times, treating more patients meant providing a lower quality of care at the expense of the patient and the practice.

Value Based Reimbursement

Value based reimbursement holds patient care at the center and makes it easier for patients to get the care they need and only the care that they need.  This model pays doctors, hospitals and healthcare facilities for keeping patients healthy and improving the health of people with chronic illnesses.

What Will Change?

Healthcare providers need to focus on transitioning their business model to one centered around tracking patient data throughout networks. Patients should be encouraged to change behaviors and get healthier, not herded through to achieve high volume. In turn, patients with value-based reimbursement will be more invested in their healthcare and have motivation to improve. Financially, healthcare facilities need to transition to accepting value-based payments.

This restructuring period is a great time to have an evaluation performed on your facility’s systems to see where you can further reduce costs and increase efficiency. Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

Telehealth Consultation Requirements for Maryland Mental Health Providers

The Tele-mental Health Guide defines tele-mental health as “the provision of mental health services using live, interactive videoconferencing.” We recently shed some light on the benefits of tele-mental health services for both practitioners and patients. Many agree that convenient remote access to mental health services will increase efficiency and allow patients in underserved areas to receive continuous quality care on a greater scale.

If you are a Maryland mental health provider you may be wondering, “Where can I sign up?” Let’s discuss the next steps and potential barriers to implementing telehealth consultations.

Telehealth Consultation Requirements in Maryland

The regulations governing the provision of telehealth services varies state-to-state, and this can get tricky if you plan to practice with patients across state lines. According to the Maryland Health Care Commission, telehealth consultation requirements include the following:

  • Licensing – A physician must be licensed in the State if either or both the individual practicing medicine or if the patient is physically located in Maryland
  • Credentials – If a multi-site hospital credentials physicians specifically for the site at which they are located, every physician within the hospital system must be credentialed at all hospital sites in order to provide telehealth services
  • Liability – A physician must work with their insurance carrier to determine if coverage is available and if so, the extent of coverage allowed under their policy (liability and malpractice insurance for tele-health services varies by carrier)
  • Financial – Physicians must purchase and maintain equipment for these services
  • Staffing – For organizations interested in providing telehealth services, access to providers that are able and willing to provide these services and support the needs of the organization as they implement and grow their services is a must
  • Registration – Those registering to be telehealth providers must be enrolled in the Maryland Medical Assistance Program and register as an originating or distant site via an online form before rendering services

Technical Requirements for Telehealth Consultations in Maryland

According to the Maryland Medicaid Telehealth Provider Manual, providers shall, at a minimum, meet the following technical requirements:

  • A camera that has the ability to manually, or under remote control, provide multiple views of a patient with the capability of altering the resolution, focus, and zoom requirements according to the consultation
  • Have display monitor size sufficient to support diagnostic needs used in the telehealth service
  • Bandwidth speed and image resolution sufficient to provide quality video to meet a minimum of 15 frames per second, or higher, as industry standards change
  • Audio equipment that ensures clear communication and includes echo cancellation
  • Creates audio transmission with less than 300 millisecond delay

Provider Registration – Take the First Step to Implementing Telehealth Today

If you are a provider who is interested in offering consultations, you may be enrolled in the fee-for-service (FFS) program or a HealthChoice managed care organization (MCO). Don’t let the requirements overwhelm you – be proactive! Taking the first required step is simple, all you have to do is fill out this Telehealth Registration Form. To complete the registration process you will need:

  • Your Maryland Medical Assistance provider number
  • Your National Provider Identification (NPI) number
  • An email account to receive for communications from the Telehealth team

*Note: After Medicaid verifies your registration information, you will receive a confirmation email. Until Medicaid confirms your registration, providers should not bill for telehealth services. If you have any questions, you should email dhmh.telemedicineinfo@maryland.gov or refer to this Telehealth Provider Manual*

Need Help with Practice Management? Contact Vetters Enterprises, LLC Today

Vetters Enterprises is a full service practice management company specializing in practice management, revenue cycle optimization, and private practice support. Give us a call at 443-352-0088 or contact us online if you’d like to see how we can help improve your cash flow.

Provide Quality Care through Tele-mental Health Consultations

The National Alliance on Mental Illness reports that anxiety, depression, substance abuse and other psychological ailments affect nearly one in five Americans, or 43.8 million people. However, it can be difficult for people with behavioral problems to seek help from a mental health professional and receive an accurate diagnosis. Mental health services are often offered in abundance in urban and suburban areas, making it difficult for people in rural areas to conveniently access the help that they need. That’s where tele-mental health comes in.

 

What is Tele-mental Health?

The Tele-mental Health Guide defines tele-mental health as “the provision of mental health services using live, interactive videoconferencing.” It makes sense, doesn’t it? In an instant we can use videoconferencing to virtually connect face-to-face with our friends, out-of-state relatives and business associates – so why not use this technology to serve mental health patients from afar? Tele-mental health consultations are an increasingly popular way to provide quality mental health services to those living in underserved communities with limited clinicians.

What are the Benefits of Tele-mental Health Services?

Without convenient access to mental health services, those suffering tend to neglect seeking proper treatment. Who wants to drive 200 miles out of town to the closest specialist for continuous care? In the past, patients were forced to make that kind of time and shell out for gas, potential childcare and missed work days if they wanted to be seen. Tele-mental health consultations provide mental health access like never before for both doctors and patients. Some of the benefits associated with tele-mental health services include:

  • Access to patients worldwide, resulting in an increased patient pool for practitioners
  • Ability to facilitate an immediate 3-way consultative session with a specialist through video conferencing, allowing for more comprehensive care on the same visit
  • Higher consumer and practitioner satisfaction
  • Increased convenience and efficiency
  • Minimized/eliminated travel costs for patients
  • Increased comfortability for those who find it difficult to open up to specialists in person
  • Same day psychological test results
  • Reduced emergency care costs (by diagnosing and treating illnesses earlier on).

What is the Goal of Tele-mental Health Services Moving Forward?

The primary goal of tele-mental health services is to provide patients with the highest quality comprehensive care. Many clinical groups and medical professionals that have employed tele-mental health capabilities have reported that the efficiency of remote care is on par with in-person care.

Want more useful information? Visit our blog again! Vetters Enterprises is a full service practice management company specializing in practice management, revenue cycle optimization and private practice support. Contact us today if you’d like to see how we can help you improve your cash flow.