Adding New Providers to an Established Practice

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Adding New Providers to an Established Practice

Adding new providers to an established medical practice is crucial for growth and enhanced patient care.

It’s a process that involves meticulous planning, understanding insurance complexities, and ensuring seamless integration of new personnel.

This guide delves into the essential steps for adding providers to your practice, ensuring compliance with insurance credentialing, and addressing critical financial and legal considerations.

Key Takeaways

  • Understanding the insurance credentialing process for new providers.
  • Recognizing the importance of having the necessary documents for provider credentialing.
  • Evaluating insurance considerations and reimbursement rates.

Confirm Insurance Credentialing

Insurance credentialing is the first critical step in adding new providers to your practice.

Before these providers can begin seeing patients, they must be credentialed with the insurance companies your practice is affiliated with.

This process involves:

  • Contacting the insurance companies to check the credentialing status of the new providers, using their full legal names and individual NPI numbers.
  • Ensuring new providers have an NPI number is mandatory for credentialing.

Step-by-Step Credentialing Process

Credentialing Process and Timelines

Credentialing varies depending on the provider’s background:

  • Providers with Prior Credentialing: This process is usually quicker if the providers are already credentialed with the insurance companies.
  • New Providers: Those without prior credentialing will need to start from scratch, which can be lengthy.

It’s important to note that even for previously credentialed providers, the process can take up to three months or more, with potential delays due to background checks and insurance company vetting.​

Required Documents for Credentialing

When adding new providers, various documents are required for successful credentialing. These include:

  • Personal details like name, date of birth, and contact information.
  • Professional documents such as qualifications, licenses, certifications, and malpractice policy.
  • Practice-related details, including practice tax ID and insurance coverage details.

Each document ensures the provider is fully authorized to deliver care under your practice’s banner.​

​Considering Provider Insurance Coverage

When adding a new provider, several insurance-related considerations come into play:

  1. Prior Acts Coverage: Determine if your practice will provide prior acts coverage for new physicians. This will affect the risk and insurance costs your practice will incur.
  2. Tail Coverage: Assess the need for tail coverage for physicians, especially if they are not covered for prior acts.
  3. Retirement Considerations: For physicians nearing retirement, understand the conditions under which they might receive free tail coverage from insurance companies​

​Managing Financial and Legal Aspects

Building a Supportive Environment

Creating a supportive environment for new providers is crucial for their successful integration:

  • Orientation and Training: Develop a comprehensive orientation and training program to acquaint new providers with your practice’s protocols and culture.
  • Mentorship Programs: Consider implementing mentorship programs to foster professional growth and development.
  • Feedback and Evaluation: Establish a system for regular feedback and performance evaluation, promoting continuous improvement and satisfaction.

​Insurance Requirements and Reimbursement Rates

Understanding the nuances of insurance requirements is crucial.
Different insurance companies have their own set of rules for adding new providers.
Moreover, reimbursement rates can vary; mid-level providers often receive lower rates than physicians.
This has significant implications for your practice’s financial planning.

Hiring and Marketing the New Provider

The hiring process for a new provider should be thorough and considerate of your practice’s needs.

Once hired, effective marketing strategies are vital for integrating the new provider into the community and attracting patients.

This may include community lectures, meetings with potential referring sources, and active involvement in the medical community.

FAQs

How long does the credentialing process typically take when adding a new provider?

The credentialing process can take anywhere from 2 to 4 months, and sometimes up to 6 months if there are delays or incomplete documentation.​

​What are the key documents required for provider credentialing?

Essential documents include personal identification, professional qualifications, licenses, certifications, malpractice policy, and practice-related details like tax ID and insurance coverage.

​How does adding a new provider impact insurance considerations for a practice?

Adding a new provider requires prior acts coverage, tail coverage, and assessing the impact of previous claims on insurance costs.​

​What strategies should effectively integrate a new provider into a practice?

Effective strategies include thorough hiring processes, strategic marketing, community engagement, and ensuring active involvement in the medical community.​

​Are there different reimbursement rates for mid-level providers compared to physicians?

Yes, mid-level providers often receive lower reimbursement rates than physicians, which is a significant financial aspect to consider when expanding your practice.​