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This one is a doozy that can really cause huge problems when opening an urgent care. Without the proper payer contracts lined up beforehand, your claims can stall, and revenue for your new urgent care can dry up quickly.
While an urgent care clinic may mainly operate with physician assistants, medical assistants, or nurse practitioners, at least one licensed physician is needed on staff. Not only do physicians need their medical license to practice, it is also necessary to have insurance credentialing for physicians. Credentialing is the process of having a physician affiliated with major insurance companies in your area so your clinic can accept third party reimbursement.
Physician credentialing allows clinics to receive steady payments; it also means physicians can see more patients, as physicians will be in-network or preferred providers for insurance companies. Credentialing procedures vary from payer to payer, so decide which insurance companies you’ll participate with and start the process as soon as possible.
Once you’re credentialed, begin setting up contracts with the major insurance companies in your area. Starting the contracting process ahead of time (generally six months before opening) helps ensure you have rates and discounts agreed upon before you receive patients. Front desk collections will be an important piece to your clinic’s overall reimbursement. Having a fee for service (FFS) or cash payment schedule in advance will allow the front desk staff to collect the appropriate amount before the patient is seen.
If your clinic is unsure on how to do credentialing and contracting correctly, hiring consultants with experience in this area is advisable. To ensure legal compliance, it’s also recommended that you examine state laws for both physicians and your clinic office so you meet all regulations.
Bottom line: Make sure physicians have insurance credentialing, negotiate contracts with payers well in advance, and verify you have the correct licenses to operate in your state and clinic location.
(Want to see all six mistakes to avoid when starting an urgent care? Download our free whitepaper!)
We wonder what works best. Did you do contracting and credentialing yourself or did you hire someone to help? Stay tuned for mistake #5.