True Cost of Running a Clinic Part 3: Licensing & Credentialing

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Last time on our True Cost of Running a Clinic blog series, we discussed creating a business plan and obtaining capital to open a clinic. This time we will be discussing two more very important aspects: licensing and credentialing. Before a provider can get their practice up and running, they need to follow relevant regulations set by the federal government and their state. Many regulations are specific to medical specialties, but there are some basic requirements that most physicians need to follow, one of which is state licensing.  The Federation of State Medical Boards’ website has a list of each state’s board. The provider must also obtain a National Provider Identification (NPI) number to be able to practice. Medicare, Medicaid and private insurance companies use this number to keep track of health providers. One can apply for on the National Plan and Provider Enumeration System website.

Apart from the usual essential regulations, there are also several additional regulations including specific rules depending on the type of medicine one practices and the procedures one provides. For example, if there is an in-office laboratory, then certification by the Clinical Laboratories Improvement Amendment program through the U.S. Centers for Medicare and Medicaid Services is required.

The provider will also need to get themselves credentialed to submit claims to the different insurances one would be working with. The credentialing process can take up to four months, but Physician’s Practice suggests giving yourself as long as 150 days in case something goes awry. The provider will need to navigate the process for each insurance plan they want to submit claims to, which includes offering up information on work history, proof of malpractice insurance, hospital privileges, attestations and more. What this also means is that even though you can begin participating in insurance plans, you should not expect to get reimbursed until you get credentialed. However, Symbiosis™ will provide you assistance with getting credentialed with insurance providers, registering your business, accounting, payroll and taxes. In addition, we will also help you negotiate contracts with insurance providers. Licensing and credentialing may seem daunting, but you don’t have to go it alone. You take care of your patients and we’ll take care of the rest.