BC Advantage - 2020 Issue 9
Contracting and Credentialing: The Often-Neglected Keys to Practice Success
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Article Overview
This article examines two foundational business functions for independent practices: payer credentialing and payer contracting. It explains why these administrative processes matter, how they affect revenue and operational continuity, and why some practices choose to handle them internally or outsource them. The piece is aimed at practice owners, administrators, and physician leaders who want a broad understanding of the organizational and financial issues involved in maintaining payer relationships.
Why This Topic Matters
Credentialing and contracting can influence whether a practice can see patients, receive reimbursement, expand, and maintain predictable cash flow. Understanding the operational challenges around these functions helps practices evaluate internal workflows and outside support options.
Article Sections
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Payer Credentialing: Administrative Headache, Payer Cost Saving, but a Keystone Habit
This section discusses the administrative role of credentialing in practice operations and the operational problems that can arise when it is handled inconsistently. It also covers workflow approaches such as internal tracking and outsourcing.
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Payer Contracting: Keeping an Eye On Your Reimbursements
This section focuses on payer contracts as a central business concern for independent practices. It addresses reimbursement oversight, negotiation considerations, and the choice between in-house management and outside assistance.
What You Will Learn
- Why credentialing and contracting are important to independent practice operations
- How these administrative functions can affect revenue and growth planning
- Common workflow approaches for managing payer relationships
- Factors practices may consider when choosing internal versus outsourced support
Who Should Read This
- Independent practice owners
- Physician practice administrators
- Medical office managers
- Revenue cycle and business operations staff
- Physician leaders
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