Listen Up, Doctors—You Really Need to Know This
The Buck Starts Here!
By Cara Smith
And that goes for you, too, dentists, optometrists, podiatrists—indeed, all healthcare professionals, whether you’re an average medical practice, urgent care facility, or large multi-specialty clinic; or a solo practitioner just starting out. Chris and Tia Aspra, who, along with partner Pam Kendricks, own and operate the medical billing, credentialing, and consulting powerhouse that is The FIRM, have some critical words of wisdom about insurance credentialing—that murky, agonizing quagmire—that they really want you to hear.
First, though, it’s worth pointing out just how important insurance credentialing really is, and what makes The FIRM so great (in addition to their flexed up resources and decades of combined experience, of course). It’s quite simple, explains Tia. “Credentialing—that is, your contracts with insurance companies—directly impacts your collections. If there’s a problem, you won’t be able to collect,” she says. “We realized long ago that billing and credentialing were inextricably linked, and that’s why we created The FIRM. We all understand both processes, which is what allows us to get maximum results for our clients.”
With that in mind, let’s turn to some all-important truths about credentialing Tia would like to share, starting with the first: credentialing is extremely complicated. “All too many providers think it’s a mere matter of sending a few faxes,” says Tia. In fact, it’s a multi-stage, multi-tiered process, which needs to be done correctly and tracked meticulously every step of the way; even worse, every insurer has different requirements. In other words, your office manager, no matter how competent, may soon be in over her head. “We make sure nothing falls through the cracks,” says Tia. “And while we can’t guarantee you’ll get a contract, we can promise that, if you’re eligible for one, we’ll get it for you.”
Second, credentialing doesn’t travel with you. Warns Tia, “Never think that, once credentialed, you always will be.” Whether it’s with private insurance companies or government-sponsored programs, like Medicare and Medicaid, your credentialing is tied to your current practice. That means that if you move to a new one or open your own, you’ll have to do it all over again—or not get paid. Finally—and this is especially important for hiring docs—you can’t solve credentialing problems by billing another doctor’s services under your name (or vice versa). “While non-physician providers can bill under a physician’s name in certain instances, it’s against the law for another physician to do so,” explains Tia. In fact, Tia’s so well versed in this and other credentialing topics that she routinely lectures state- and even nation-wide at medical law and CME seminars. The bottom line? The folks at The FIRM know their stuff—really know it, and know how to get results. And with a recent expansion from Kerrville into Austin, they’re ready to flex their muscles for you. “We’re the caretakers of your biggest asset: your accounts receivable,” says Tia. “We’re here to keep the money coming in—and the worry going out.”