BC Advantage - 2020 Issue 7
Contracting & Credentialing: The often neglected keys to practice success
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Article Overview
This article discusses two practice-management areas that are often overlooked in independent and small-group settings: payer credentialing and payer contracting. It explains why these processes affect operational continuity, growth, and reimbursement, and it outlines general approaches practices use to manage them internally or through outside support. The piece is aimed at practice owners, administrators, and staff responsible for revenue cycle and payer relations.
Why This Topic Matters
For independent practices, payer enrollment and contract management can influence whether services are payable and how sustainably the practice can grow. The article frames these functions as essential business processes that affect revenue, staffing, and long-term operational stability.
Article Sections
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Payer Credentialing: administrative headache, payer cost saving, but a keystone habit
Introduces credentialing as a routine administrative process tied to payer participation and practice operations. The section discusses common workflow challenges and general management approaches.
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Payer Contracting: Keeping an eye on your reimbursements
Focuses on payer contracting as a core business function for practices. The section covers broad themes related to reimbursement oversight, negotiation, and organizational planning.
What You Will Learn
- Why credentialing is a foundational administrative process for practices
- How payer contracting can affect practice growth and reimbursement
- Common operational challenges associated with managing payer paperwork and timelines
- General options for handling credentialing and contracting internally or through outside services
Who Should Read This
- Physician practice owners
- Practice managers
- Revenue cycle staff
- Medical office administrators
- Independent and small-group providers
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