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In the rapidly evolving world of healthcare, the role of a Medical Credentialing Specialist has never been more critical. "Medical Credentialing Specialist - The Comprehensive Guide" is the quintessential resource for professionals aiming to master the intricate processes of medical credentialing and privileging. This book distills complex regulations and procedures into an accessible format, ensuring readers not only comprehend the foundational principles but also excel in applying them within any healthcare setting. With a focus on practical strategies and real-world scenarios, this guide demystifies the credentialing process, making it an indispensable tool for both novices and seasoned professionals. Understanding the high stakes involved in credentialing for patient safety and organizational integrity, this comprehensive guide emphasizes the importance of accuracy, efficiency, and compliance. It navigates through the myriad of standards and legal requirements with precision, offering up-to-date insights into industry best practices. Note, to respect copyright laws and ensure universal accessibility, this book does not include images or illustrations. Instead, it enriches the reader's understanding through detailed explanations, case studies, and hypothetical scenarios that bring the credentialing world to life. By prioritizing clarity and practicality, this guide stands as an essential read for anyone looking to thrive in the healthcare credentialing field.
This handbook enables your organization to systemize the tedious, ongoing, and mandatory process of credentialing your medical staff and to understand why you must! Healthcare organizations must have credentialed medical staffs to deliver their services. The reasons are two-fold: First, educated, licensed, experienced, and proven caregivers ensure that a hospital or medical practice is capable of delivering quality care. Secondly, payers require that the physicians and other licensed healthcare professionals are qualified and licensed to work with their patients. Before receiving payment for services, the provider must have specific credentials for providing that service. Verifying and documenting the credentials of a healthcare provider is tedious, ongoing, and mandatory. An organization with a large medical staff may struggle with keeping the credentialing function current, as many licenses have rolling expirations. Credentialing ensures that clinical practitioners are duly qualified, licensed, and board certified. It reports the history of malpractice claims, state-instituted sanctions, or other undesirable professional circumstances of providers. Credentialing and privileging of healthcare professionals protects patients and hospitals by minimizing the risk of medical errors that may result from the work of incompetent providers. It also undergirds the reputation and credibility of the institution in the eyes of providers and across the healthcare community. Further, credentialing with insurers forms the basis for reimbursement for professional services. Without the acceptance of the professional credentials of a provider, insurers and other third-party payers will not compensate his or her claims. The purpose of this book is to explain the necessity and to provide the process for the official documentation of each practitioner. The information presented in these chapters will serve as a practical resource for strengthening your organization's credentialing function. = Book Features! -Outlines the necessity for credentialing in the delivery of care and in attaining reimbursements for services provided -Explores options for in-house and outsourced credentialing function -Provides systematic process for ongoing credentialing operations
The Certified Provider Credentialing Specialist Passbook(R) prepares you by sharpening the skills and abilities necessary to succeed on your upcoming entrance exam.
The Credentialing Handbook provides comprehensive, plain-English guida nce to understand and master the provider credentialing process in any health care setting. With sample forms, checklists, flowcharts, and c orrespondence, this practical guide walks you through every aspect of effective credentialing, appointment, and recredentialing. You'll lear n: key steps in the credentialing process; about express credentialin g models; how to credential allied health practitioners; typical time frames and tracking systems; pros and cons of delegating credentialin g, plus more.
"The Army physician assistant (PA) has an important role throughout Army medicine. This handbook will describe the myriad positions and organizations in which PAs play leadership roles in management and patient care. Chapters also cover PA education, certification, continuing training, and career progression. Topics include the Interservice PA Program, assignments at the White House and the Old Guard (3d US Infantry Regiment), and roles in research and recruiting, as well as the PA's role in emergency medicine, aeromedical evacuation, clinical care, surgery, and occupational health."--Amazon.com viewed Oct. 29, 2020.
The role of the MSP is expanding to include payer enrollment and delegated credentialing responsibilities for managed care organizations. Traditionally siloed, MSPs are now beginning to take on both responsibilities, which means they must learn the nuances of managed care credentialing as well as the regulatory and accreditation requirements of NCQA, CMS, and URAC. Managed Care Credentialing: Compliance Strategies for Health Plans, CVOs, and Delegated Entities provides the answers to MSPs' inevitable questions as they begin to manage the tasks of payer enrollment and delegated credentialing. Author Amy M. Niehaus guides readers through each payer's requirements, the differences between hospital and managed care credentialing, and how to help their organization establish delegated credentialing agreements and prepare for audits. As new and existing MSP responsibilities begin to collide, this resource also outlines ways MSPs can modify their current processes to reduce duplication of efforts and develop a comprehensive and compliant managed care credentialing program. Whether you are new to managed care credentialing or are taking on delegated credentialing responsibilities, this book will help you: Learn the regulatory and accreditation requirements related to managed care credentialing Streamline the provider enrollment process through delegation Meet your organizational goals of compliance, operational efficiency, cost savings, and practitioner satisfaction Identify the differences between hospital and managed care credentialing
The definitive guide to starting a successful career in medical billing and coding With the healthcare sector growing at breakneck speed—it’s currently the largest employment sector in the U.S. and expanding fast—medical billing and coding specialists are more essential than ever. These critical experts, also known as medical records and health information technicians, keep systems working smoothly by ensuring patient billing and insurance data are accurately and efficiently administered. This updated edition provides everything you need to begin—and then excel in—your chosen career. From finding the right study course and the latest certification requirements to industry standard practices and insider tips for dealing with government agencies and insurance companies, Medical Billing & Coding For Dummies has you completely covered. Find out about the flexible employment options available and how to qualify Understand the latest updates to the ICD-10 Get familiar with ethical and legal issues Discover ways to stay competitive and get ahead The prognosis is good—get this book today and set yourself up with the perfect prescription for a bright, secure, and financially healthy future!
After years of school and maybe even after some years of practice, you are ready to do it on your own. Running a profitable business takes more than just being a great doctor. Start Your Own Medical Practice provides you with the knowledge to be both a great doctor and a successful business owner. Whether you are looking to open a single practice office or wanting to go into partnership with other colleagues, picking the right location, hiring the right support staff and taking care of all the finances are not easy tasks. With help from Start Your Own Medical Practice, you can be sure you are making the best decisions for success. Don't let a wrong choice slow down your progress. Find advice to: --Create a Business Plan --Manage the Office --Raise Capital --Bill Your Patients --Market Your Practice --Build a Patient Base --Prevent Malpractice Suits --Keep an Eye on the Goal With checklists, sample letters and doctor's office forms, Start Your Own Medical Practice teaches you all the things they didn't in medical school and gives you the confidence to go out and do it on your own.