Feel free to post any questions related to opening a new practice and we will be happy to help. Credentialing and starting a new practice is a major headache so don’t try to go it alone. Please utilize the Practice Forum for free assistance.
We welcome your credentialing, insurance or practice start-up questions and would be happy to assist you. Starting a medical practice is one of the most difficult things a physician could ever do. It is unfortunate, but most medical programs do not provide physicians with the necessary training to start a practice effectively.
I am interested in obtaining credentialing services for a new practice startup.
I work for a solo doctor with a solo npi number. He is thinking of adding a physician and just billing services reciprocal under him. I’m not sure if we can do this or if the doctor will also have to be considered a solo doctor and we bill out under her npi and get her credentialed with the health plans. Or do we need to redo our practice as a group practice. This doctor will just be filling in two days a week?
Unfortunately, unless the doctor only plans on staying for 60 days(locum rules), you will need to credential the physician and change your practice to a group practice. You do have the option of setting her up as an independent contractor but have to be aware of fee splitting and stark regulations and how they apply to your structure. Regardless of whether the physician is an employee or an independent contractor, the physician will need to obtain a Medicare number and be set up with all commercial carriers either as an individual under her own EIN or under new group agreements with your EIN.
Let me know how we can help.
What does it cost the physician to be credentialed by a health plan; or, assuming he is credentialed by multiple healthplans, what is the cost of his doing so with each? Thank you.
The cost depends on the health plan. Typically, we credential a practice or physician with all insurance carriers (up to 25) and Medicare for one price then have a separate price scale for a la carte credentialing. We have different prices for CAQH registration, Medicare Applications and Commercial carriers. It it always best for us to understand your need then deliver to you a custom proposal based on these needs. Most of the time physicians are unaware of all that is really involved in the credentialing process until claims start getting denied.