In the past few blog installments, we’ve talked about credentialing for medical staff privileging and for payer participation credentialing. Just when you thought we had covered all the issues that could possibly affect even the most well-planned start-up, there are a couple more nuances to review that many who are contracting with physicians may not be aware of. See the following to avoid those potential pitfalls!
Whether we are talking about medical staff or financial credentialing, physicians must declare not only their specialty but their scope of practice within that specialty. In the medical staff world, we refer to this as delineation of privileges (sometimes referred to as “DOPs”). This is necessary simply because not all physicians in a given specialty work within the same delineation.
Why? This may occur because of sub-specialty concentration, or because they have not performed certain procedures frequently enough since completing their training to be proficient. Furthermore, one cannot assume that all family medicine physicians are credentialed to work at all practices affiliated with one organization.
For example, a family medicine physician that is credentialed for outpatient community practice cannot “automatically” work in the hospital seeing inpatients; or even at the hospital’s urgent care facility. Same stipulations would apply to a hospitalist who wants to moonlight in the urgent care facility or one of the hospital-owned practices. These sites and privileges are considered different entities and most hospitals now require physicians to add those additional practices to their request for privileging. The request may take a few days, or in the case of some, have to go back through the credentialing process altogether. This is also applicable to payer credentialing. Even when one of your employed doctors moves from one location to another, you must update the locations with all payers or you may run into issues in terms of collections.
Multi-Locations and Payer Credentialing
While we’re on the topic, it’s important to always perform proper due diligence in terms of the “participation list”. When a provider says they are already participating with specific payers and gives you a list, it doesn’t necessarily mean that the participation agreement is for just any hospital, practice, or location. The participation agreement is likely for certain worksites– more specifically the sites that were on the application and Tax ID Number (TIN). So if Dr. XYZ is now filling in up the street or across the country, the participation agreement may not allow for billing unless these particular sites were added and proper protocol was followed. In the case of locum tenens, that would mean submitting a full application for the correct TIN and locations that the provider is being used. Also, be cautious in assuming that a provider who is enrolled in Medicare can just submit a change of location and voila! you can bill. The bottom line to remember is, in order to achieve the proper ROI in terms of using a locum tenens provider, you must follow procedure carefully and partner with a firm who can assist you properly.
Still have questions? Contact us to find out more. The All Star Recruiting way is to assist our nationwide clients in any way possible to ensure the best possible outcome.
Arlene Macellaro is the VP of Business Development and Client Relations for All Star Recruiting. She can be reached at AMacellaro@allstarrecruiting.com.
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