healthcare compliance and credentialing

The phrase “locum tenens” is Latin and translates to “placeholder.” This term can refer to anyone who fulfills the duties of another person on a temporary basis. In the healthcare domain, a locum tenens refers to a substitute physician hired to take over a regular physician’s professional practice when the regular physician is absent for reasons such as illness, vacation, pregnancy, or continuing medical education. For the patient, the locum tenens provider performs the same services as his or her regular physician.

Many people don’t know the difference between the credentialing and provider enrollment roles in business. That’s not surprising, as most people don’t have the need to know. You may, however, be surprised at the number of those in the healthcare industry that do not know the difference. While it is true that the two jobs are intertwined, there are distinct differences between the two that I'd like to make clear in order to help clarify why the enrollment specialist is often confused with a credentialing specialist. 

Mergers and acquisitions are not usually the subject of conversation in medical circles. In general, the merger or acquisition of a healthcare practice with another is almost always a grueling and tedious process; however, it doesn't have to negatively impact your staff or your reimbursements.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for healthcare providers to facilitate the simplification of the administration and transmission of healthcare data between providers, healthcare facilities, insurers and governmental oversight agencies. In particular, the National Provider Identifier (NPI) must be used in connection with all of the electronic transactions identified in HIPAA. Key to this mandate was the development and implementation of the National Plan and Provider Enumeration System (NPPES) that collects identifying information on health care providers and assigns each one a NPI. The NPI is a unique 10-digit identification number and is mandated for use by:

It’s a fair assumption that healthcare providers didn’t become involved in medicine to fill out paperwork. No other vocation requires as much documentation and scrutiny which offers an opportunity for hospitals and other healthcare facilities when it comes to finding and hiring the best and brightest talent. In short, finding the right talent, doctors and nurses, is expensive and requires a commitment to onboard them efficiently, allowing them to practice medicine and not bogging them down with paperwork. In fact, it could be a key reason why a provider chooses your organization over your competitor. Accomplishing this goal may seem a daunting task but partnering with a payor enrollment service can help immensely in several key areas: Communicating About Every Detail

Healthcare Organizations are very busy with the recent trend of direct physician employment versus relocation assistance and guarantee arrangements that were once the model of choice when recruiting physicians. The executives of these organizations face an ever growing challenge of allocating ever tightening resources, while focusing on the types of activities required to remain competitive in the marketplace.