Q. What is credentialing?

A. It is a process by which insurance carriers and hospitals verify the credentials of the medical provider. This includes verification of licenses, verification of malpractice insurance, verification of college degrees and background checks to disclose any felonies or criminal activity.

Q. Why is credentialing important? Who is it important to?

A. It is important to the provider to maintain his credibility with the insurance carriers and to hopefully receive a contract to participate in an insurance companies various programs. This is critical to a medical provider due to the fact that most of us want to see a doctor in our network as it creates a savings for us with our medical expenses. Most out of network benefits require us, the patient, to meet a deductible before any payments to the provider of services are made.

Q. How does credentialing help the medical provider?

A. Once a medical provider is credentialed and accepted into an insurance plan, their information is then posted in the provider directory. If a patient is looking for a medical provider in their network, they usually search by zip code. If a medical provider is not listed in that directory, the medical provider has missed the opportunity to get a new patient. Therefore, credentialing in a sense is a marketing tool as well.

Q. How does a medical provider go about the process of credentialing?

A. Credentialing is an extremely time consuming process and requires an individuals’ undivided attention. Current documents must be attached to a standard application which should be type written for legibility. Documents include licenses, diplomas, resumes, and declaration pages of the current malpractice. A cover letter should accompany the application and documents, introducing the provider to the carrier or hospital. Most providers use an outside service for this process.

Q. How long does it take to be credentialed?

A. Most carriers take from 90-180 days to complete their credentialing process. Once the provider is credentialed, the applications goes before a committee for final acceptance into an insurance plan.

Q. How will the provider know if they are accepted into a plan?

A. Most carriers inform the provider via letter along with a welcome packet of some type. Another method is to track your application which requires someone to contact the carrier every couple of weeks to check the status of the application.

All in all, credentialing is a very important part of the medical providers’ business.

Michele Graham
CEO and Owner of Professional Healthcare Management
Billing and Credentialing Service
41 years in the healthcare industry

http://www.phmnetwork.com
http://phmnetwork.blogspot.com

http://www.healthcarenewsonline.com

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Healthcare is one of the hottest career fields in America today. The aging and retiring of the largest population segment in the country, known as “baby boomers”, has left the healthcare industry racing to find enough employees to fill the void. Advances in medical technology and treatment are causing people to live longer as well. Add the fact many universities and colleges don’t have enough teachers to train new employees; there becomes a ripe market for healthcare careers.

You would be amazed how many types of healthcare careers there are available. This article will discuss three main categories; patient care, non-patient care and operations. We’ll also discuss an amazing new trend with tremendous opportunity - home health.

Three main healthcare jobs in the category of patient care are nursing, medical assisting and dental hygiene.

Nursing consists mainly of direct patient care, but this can take place in a hospital, private doctor’s office, or an institution like a school, ski resort or cruise ship. With additional education or experience, some nurses become nurse managers, shift supervisors, epidemiologists, or counsel to insurance companies and law offices.

Medical assistants primarily provide patient care; performing routine medical functions to free up the time of the doctor. In the past, some of these medical services could only be provided by doctors. Medical assistants administer medication, take vital signs and update medical history.

Dental hygienists perform a similar function to medical assistants, only in a dentist’s office. A hygienist will clean teeth, advise patients on proper dental health and assist dentists with more complex procedures. The outlook for this profession is excellent, with demand far outpacing supply.

Many non-patient care positions also exist in the healthcare field.

Medical coding is one such profession. Medical coders must know terminology and how to read a patient’s chart. They update medical records every time a patient receives healthcare. Some upward mobility is available in management. Many people secure a job as a coder as a way to subsidize further medical education.

Medical office administration is another healthcare position that doesn’t involve patient care. These positions answer phones, coordinate with hospitals and check in/out patients. Moves to office management or medical coding/billing are advancement opportunities. Some people also use this position to further their education.

Healthcare institutions are a large employer of operational positions as well.

Information technology professionals are in strong demand since hospitals utilize state of the art databases to store patient’s medical and billing records. Database administrators and web programmers are a vital part of a hospital’s daily operations.

Medical billing and administration is another key component of healthcare operations. Medical facilities hire for billing positions, collections and administrative support. Special courses / experience are required in medical terminology and billing to obtain these types of jobs.

A rapidly growing sector of healthcare where all of these positions are required is that of home health. In the next six years, Medicare funding of home healthcare is expected to double. Over 7.6 million patients are being treated at home for both long term and short term care. Home healthcare is considered by the medical field and health insurers to be the most cost effective, humane and compassionate method of care.

The shortage of experienced healthcare workers in the United States is creating a boom for people who want to enter this field. There are many career options including positions that involve patient care and those that don’t. The current shortage of employees has created excellent starting salaries, generous benefits and signing bonuses.

For more information on how you can get the proper training, go here www.top-colleges.com.

About The Author

Max Stein, Salt Lake City, UT, USA

http://www.degreesource.com/articles

Max Stein is a freelance writer who writes about business, education and marketing.

For daily updates, read our blog at http://degreesource.blogspot.com

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In 1997, the Food and Drug Administration relaxed its restrictions on direct-to-consumer marketing of pharmaceuticals. Prior to this ruling, drug manufacturers were prohibited from mentioning both the name of the drug and its indications in consumer-directed advertisements without also including a large amount of technical information about the drug, including all known side effects, contraindications, and dosage recommendations (Stevens, 1998).

In addition to interfering with the appeal of the advertisements, such requirements
rendered broadcast ads infeasible due to time constraints, and hindered ads in print
media due to cost and space availability. These requirements were abolished in the
1997 FDA policy changes, and pharmaceutical companies were permitted to market
drugs by name as treatments for specific conditions, with the minimal requirement
that ads give mention to major risks identified in clinical trials (Melillo, 2001). As a
result, manufacturer expenditures on direct-to-consumer advertising, which totaled
$791 million in 1996, rose to $2.6 billion for the year 2000 (Mitchell, 2001).
Television, radio, and print media became saturated with ads promoting treatments
for conditions ranging from depression to high cholesterol.

Names such as Zoloft, Claritin, and Lipitor, which were previously known mostly to
health professionals, quickly became part of the national vocabulary. Consequently,
spending on prescription drugs has increased significantly over the past several
years as consumers are enticed to seek advertised medications (HealthBizNews.com,
2001). This new face of drug marketing has sparked a raging debate about the
accompanying effects on the health of the American public: does direct to consumer
marketing benefit the public by providing education about available treatments, or
does it diminish the quality of healthcare by raising costs and causing unnecessary
treatment? Proponents of direct-to-consumer, or DTC, pharmaceutical advertising,
most prominently the drug companies themselves, argue that DTC marketing
results in improved public health by increasing consumer awareness. According to
this view, direct marketing to the consumer alerts the public of the availability of
treatment for a given condition, a fact of which it may not otherwise be aware. This
knowledge may prompt people to seek medical help rather than unnecessarily
accepting their ailments (Miller, 1998). Furthermore, supporters claim that ads raise
awareness of undiagnosed conditions by providing information about symptoms.

Since countless Americans suffer from undiagnosed disorders-only half of the
estimated 16 million Americans with diabetes know they have the disease-the
motivation to seek treatment provided by these ads is a valuable public benefit
(Health Matters, 1998). Similarly, by prompting people to visit a doctor, ads may
help identify conditions unrelated to the specific area of concern. For example,
according to Mike Magee, a medical adviser for Pfizer, a large proportion of
consumers seeking Viagra would not otherwise see a doctor, so visits seeking help
for erectile dysfunction often uncover conditions warranting medical attention, such
as diabetes (Shapiro and Schultz, 2000). Some doctors support DTC ads as well,
claiming that they make their jobs easier by resulting in better informed patients.
Many ads, particularly for diabetes, stress the importance of self-management of
disease, which may increase compliance with doctors orders and result in reduced
need for more extensive medical care (New York Times, 2001).

Doctors appreciate having patients who are already briefed about current drug
therapies, which saves time in a medical system that often requires doctors to see
as many as thirty patients per day (New York Times, 2001). Critics of direct-to-
consumer drug ads, including the American Medical Association, insurance
providers, and many physicians cite increasing healthcare costs, improper
prescriptions, and corrupted doctor-patient relations as this type of marketing’s
major resultant evils. Substantial evidence exists that the escalation of DTC
advertising has increased expenditure on pharmaceutical purchases. Prescription
drug spending increased 84% between 1993 and 1998, and it is estimated that
consumer-directed advertising increased drug expenditure by $13 billion in 1998
alone (Cassels, 2001).

The twenty-five most advertised drugs of 2000 accounted for forty-one percent of
expenditure on new prescriptions (Sherrid, 2000). Escalating prescription cost is of
particular concern to healthcare providers such as HMOs and large corporations,
which face a choice between curbing costs and cutting benefits (Cassels, 2001).
Additionally, those without prescription drug coverage must pay the increased rates
out-of-pocket (Shapiro and Schwarz, 2000). DTC proponents counter arguments
centered on rising costs by claiming that increased outlays on prescriptions save
money in the long run by preventing the need for more extensive medical care
(Moore, 2000). Critics, however, cite the fact that the largest portion of the drug
industry’s advertising budget goes toward drugs for non-critical ailments such as
heartburn, allergies, and hair loss (Moore, 2000).

Another argument presented by DTC opponents holds that these ads result in
incorrect prescriptions by creating consumer demand for products regardless of
actual need. Critics believe that consumers are sold the idea that a pill can instantly
provide them with good health (Health Matters, 1998). Often, however, the drugs to
which consumers are exposed are not even the most effective, but simply the ones
with the largest advertising budgets (Headden and Melton, 1998). According to
Shapiro and Schultz, patients, if refused specific prescriptions, will frequently visit
another physician, who may comply with the request (2000). In addition to
unnecessarily adding to healthcare costs, patient demand pressures doctors to give
patients the drugs they request for fear of losing business (Shapiro and Schultz,
2000). Specific drug requests, according to Dr. Angelo Agro, often cause physicians
to lose credibility in the eyes of the patient, who has been convinced by
advertisements that the drug a physician refuses to prescribe is nonetheless the
best option (Tanner, 2001).

Responding to such concerns, the AMA, at its July 2001 meeting, debated a
proposal for the organization to encourage the federal government to ban all DTC
prescription drug advertising (Tanner, 2001). While I agree that public exposure
through advertising of the latest treatments for common conditions raises public
awareness and prompts people to visit physicians, I nonetheless believe that direct-
to-consumer pharmaceutical advertising does not adequately justify its social costs.
In the case of overt maladies, such as allergies or depression, for which a large
share of advertised drugs are indicated, a condition affecting a person’s life to the
point of warranting medication would certainly cause him or her to notice it and
presumably to seek treatment. While many other products, such as cholesterol
lowering drugs, are used to treat conditions of which an individual may not be
aware and that may eventually adversely impact health, these conditions would, in
nearly all cases, be uncovered during a routine examination. In both cases, the
central benefit accomplished by these ads is getting people through the doors of
doctors’ offices, an end that can easily be achieved more cheaply without the use of
DTC advertising. For example, less expensive public service campaigns encouraging
people to have routine checkups and informing the public of warning signs of
common conditions would achieve the same results without affecting the cost of
healthcare. As the situation now stands, the benefits that do result from DTC
advertising are purchased at the price of reduced healthcare quality for some.

As drug advertising drives up the cost of treatment, healthcare providers will be
forced to cut costs in other areas and may find it necessary to compromise coverage
by denying certain procedures or raising premiums. Increased premiums may drive
people who fund their own health insurance out of the system by making personal
insurance unaffordable. Additionally higher premiums may discourage large
employers, which often independently provide their employees with health
coverage, from continuing this practice. General Motors spent $900 million covering
prescription drugs in 2000, a 19% increase over the previous year (Cassels, 2001).
Escalating costs may render those without prescription coverage unable to afford
necessary medications. Furthermore, the production of a drug is only possible when
the disease it treats becomes understood through years of basic research, most of
which is conducted by publicly funded academic investigators. Since public money
lays the groundwork for pharmaceutical production, drug companies have a
responsibility to the taxpayers not to engage in practices that will result in a
reduction in the quality of healthcare.

The major problems underlying this situation is that, under our current insurance
structure, the costs of increasing drug prices do not accrue to the consumer and
thus do not decrease demand as they should in a free market system. As a result,
the pharmaceutical companies are not given proper incentive to control prices.
Insurance providers, rather than transferring rising costs to consumers through
reduced care, need to restore the incentive to curb drug prices and hold the
pharmaceutical companies responsible for their exorbitant budgets.

http://www.lonelycanuck.com

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