Field notes
What we have learned about getting a practice paid. Written down so you can check it.
These notes cover the parts of enrollment, coverage and billing that owners ask us about most. Each one is written by HRI Med and names its sources. Read them before a call, or instead of one.
iEnrollment and panels
For a practice that is opening, or a clinician who is joining one.
Getting each payer to set a date.
- What "credentialed" means, and why nothing pays before the effective dateEnrollmentCredentialing, enrollment and the effective date are three approvals, and a claim waits on the last of them.
- The CAQH profile mistakes that stall an applicationCAQHThe gaps in a CAQH profile that hold a file in a payer's queue, and how to close them before anything is submitted.
- What a payer checks before it reads your CAQH profileChecklistEight checks per provider you can tick off on the page, with nothing to sign up for.
- Medicare enrollment for a new practice: the order of operationsMedicareThe practice goes in first, then each clinician, then the link that routes their payments to the practice.
- Closed panels: single-case agreements, network adequacy and group contractsPanelsWhat a practice can still do after a payer says its network is full.
- Who should run your enrollment: in-house, a filing service or a firm that follows throughEnrollmentThe three options set side by side on what happens after the forms go in.
iiService lines and coverage
For a practice adding something new to what it offers.
Knowing what a new service will pay before you buy for it.
- Adding a service line: the five questions every payer asksService linesThe questions a payer puts to a new service before it pays for one, and where the answers come from.
- Hyperhidrosis and other services that look cosmetic and are coveredCoverageTreatments sold in aesthetic settings that payers treat as medical care when the record supports it.
- Dentists and medical insurance: sleep-apnea appliances, TMJ and the supplier ruleDentalWhen a dental office can bill a medical plan, and the supplier enrollment that has to come first.
- Prior authorization: the weekly load, and how enrollment choices change itAuthorizationWhy the payers you join decide how much of the week goes to asking permission.
iiiPrices and fees
For an owner deciding how to pay for the work.
How the work is priced, and why ours is printed.
- Why we print our pricesPricingEnrollment is counted in applications, so the fee can be printed and the sum done by you. Billing is set from your own numbers.
- Percent of collections or a fixed fee: when each is fairFeesHow to tell which pricing model you are being offered, and which one suits the work.
Request a review
Ask the question a note did not answer.
Tell us which payers you bill today and which you still need. The review needs no patient information.
We get back to you as quickly as possible.