Medical Billing and Credentialing Services

Empowering physicians to focus solely on the demands of their clinical practice

Discover how our healthcare team can help your medical practice meet its specific challenges and position itself for the future.

Dean Dorton’s outsourced physician practice services team allows you and your organization to focus solely on the demands of your clinical practice. Healthcare professionals don’t always have enough time or resources to effectively and consistently address the ever-changing healthcare landscape. The decision to partner with a team of experts like Dean Dorton Healthcare Solutions is one that can improve the trajectory of your practice and the satisfaction of physician owners.

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Dean Dorton Healthcare Solutions

Medical Billing and Credentialing Services

Complete Back-Office Solution or À La Carte

Whether your practice needs help in specific areas or are looking for a complete back-office solution, put the expertise of Dean Dorton Healthcare Solutions to work for you.

Case Study: Dean Dorton’s medical billing services help open a path for Surgical Care Associates to expand their presence

Surgical Care Associates uses Dean Dorton’s healthcare consulting team to develop innovative solutions to medical billing, coding, and revenue cycle issues.

What is the Medical Billing and Credentialing Application Process

The medical billing and credentialing process is the process of submitting insurance claims for reimbursement for medical services rendered. The process begins with the provider, who must first obtain a National Provider Identification (NPI) number from the Centers for Medicare and Medicaid Services (CMS). The provider then submits an application to be credentialed by each insurer with whom they wish to participate.

The insurer reviews the application and supporting documentation, including the provider’s credentials, prior experience, and malpractice history. Once the provider is approved, they are placed on the insurer’s list of network providers. Providers can then begin billing insurers for services rendered. Claims are submitted using industry-standard coding systems, and insurers reimburse providers based on their contracted rates. The entire process can take several weeks or months to complete.

Why Medical Billing & Credentialing is Important

The medical billing and credentialing process is important for a number of reasons. Some include:

  • Helps to ensure patients are accurately billed. Not only does this protect the financial health of the practice, but also ensures more accurate medical records. 
  • Helps establish that providers are properly credentialed to provide care. This provides an extra layer of quality control and risk management.
  • Helps ensure that providers are familiar with the latest coding and documentation requirements, which is important for both compliance and reimbursement purposes.
  • Helps to ensure providers are up-to-date on their CME (continuing medical education), which improves service quality and patient safety.
  • Helps ensure providers are properly screened for criminal background checks and malpractice history, adding to patient protection and risk management activities.

Benefits of Credentialing in Medical Billing

Instills Confidence

In a world where technology is constantly evolving, it’s important to have a system in place that can keep up with the changes. By having a system that is up-to-date and compliant with all the latest standards, you can be confident that your practice is running smoothly and efficiently. Not only does this give you peace of mind, but it also instills confidence in your patients. They know that they are receiving the best possible care because they are being seen by a qualified and credentialed doctor. In today’s competitive healthcare market, this can make all the difference.

Builds Patient Trust

When patients visit your practice, the last thing they want to worry about is whether or not their insurance will cover the cost of treatment. By ensuring that all of your provider’s information is up-to-date and accurate, you can help build patient trust and confidence in the healthcare system. In turn, this can lead to better health outcomes for everyone involved.

Prevents Loss of Revenue

Medical billing and credentialing help to ensure that patients are billed correctly and that providers are reimbursed for their services. However, billing and credentialing can also help to prevent loss of revenue. When claims are submitted accurately and in a timely manner, there is less chance of errors and delays. Furthermore, proper credentialing helps to ensure that providers are eligible for reimbursement from insurance companies. As a result, medical billing and credentialing can play an essential role in preventing loss of revenue.

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