When does outsourcing your credentialing make sense?

credentialing services

As we all know, healthcare facilities exist to facilitate and administer medical care to their patients. While we have advanced like never before in our cure rates, infection prevention, disease management, OR efficiency and nearly every other available metric, the roadblocks to actually running a successful practice have done nothing but increase in size. Every […]

Updated Humana Medicaid Regs in Florida

credentialing services

We received this correspondence and thought it was worth sharing to ensure all Florida groups are aware of the changes.  Please contact us if you have any questions about this or other credentialing concerns.   From Humana: Beginning April 10, 2017, claims will be denied for physicians and healthcare professionals with invalid Medicaid enrollment. To […]

CMAC Fee Schedule Tool

t is not unusual for us to be asked 3-4 times per week about fees and how much the VA or Tricare pays for a particular procedure.  The VA will typically reimburse providers at 100% of the CMAC fee schedule whereas Tricare will typically pay a percentage of the CMAC fee schedule. 

Provider Enrollment & Credentialing Position

remote credentialing specialist position

We are seeking a Provider Enrollment & Credentialing Specialist to join our team! Our company is the nationwide leader in provider enrollment and credentialing services. With over 2500 providers nationwide, our team of experts is trusted by some of the leading organizations in the country. This is a work from home or work from office […]

Athena Health Credentialing- Rocky Mountain Youth Clinics

credentialing services

We are excited to announce that Rocky Mountain Youth Clinics, with clinics throughout Colorado, has selected Physician Practice Specialists as their vendor for all enrollment and credentialing needs.  In partnership with Athena Health, we are excited to take on this project and ensure RCMY receives the services and expertise they require.  PPS has been providing […]

10 Methods To Avoid Audits

patient doctor illustration

Hint: Modifiers are your friends. If you spend a lot of your valuable time processing appeals for denied claims, it’s time to fix your problems on the first claim submission so you can save time down the road and eliminate the need for appeals. Novitas Solutions, a Part B contractor in 11 states, recently shared a tremendous amount […]

Home Robbery Prompts $90,000 HIPAA Settlement

shut up and take my money meme

You’ve taken every appropriate step to secure protected health information (PHI) at your medical practice, but have you done the same at home? A Connecticut hospital learned this lesson the hard way after a home robbery led to the possible exposure of 8,000 patients’ PHI. The case: A Connecticut hospital hired a subcontractor to work […]

Why Contracting is Still Critical When Starting a Practice

red siren

When advising clients, we strive to put ourselves in their shoes as we believe that we can’t truly help without thoroughly understanding the situation.  Over the past 10 years, we’ve had the privilege of consulting with hundreds of provider groups across the country about revenue cycle challenges, practice start-ups, payer contracting issues and payer enrollment […]

ObamaCare’s Threat to Private Practice

The payment system is forcing doctors to sell out to hospitals. The trend, and the law, will be unstoppable without reform. Here’s a dirty little secret about recent attempts to fix ObamaCare. The “reforms,” approved by Senate and House leaders this summer and set to advance in the next Congress, adopt many of the Medicare […]