When my partners and I started PMG Billing in 1998, we did billing for ANY health care practice. Within a few years we were billing for almost 30 specialties. We could barely keep up with all the nuances of each specialty. Our work product was at worst, adequate. Best-in-the-world was not conceivable.

In the early 2000s we made the difficult decision to release all non-health center clients. To be clear, deciding to focus on the mission-driven work of health centers was not hard. However, releasing millions of dollars of hard-earned contracts from other specialties was very difficult.

In the end, our passion to master health center billing and coding, focusing on the economic engine to maximize health center income (on which we were paid a small percent), and a daily commitment to literally being the best in the world, helped us become top tier in all things related to health center coding, billing, and reimbursement.

During our focused effort on health center coding and billing, credentialing and enrollment issues arose... all the time. Clients asked us to do credentialing and enrollment work and we said “yes” if only to help get us all paid. We initially did it for free and at some point, decided we could start another business vertical by charging for these services. However, it was not a primary focus and we struggled around quality of deliverables.

During the sale and final exit from our billing business, we intentionally retained the credentialing and enrollment vertical. We three liked working together and felt we could again be best of breed if we put the same passion and focus on this seemingly “simple” process. Over the last 20 months, several things have become abundantly clear:

1. Credentialing and enrollment is not simple. 
   This is especially true for health centers with the myriad of individual provider and facility types as well as numerous and variable (by client) specialties.

2. We were nuts to think we could just “add this to our billing” offering and it would be successful.

   It has taken steadfast effort to hire talent and educate the team to master HRSA requirements, 855-I, 855-P, 855-R, CAQH, (not always so) common apps, DEA research, primary vs. secondary source verifications, etc.

3. Billing companies that throw this in for free or a nominal amount of money (or in house health center staff doing it as a stop gap), are creating liability for all involved.

   Aside from lost income, few really understand the unintentional harm done by not adequately or appropriately affording privileges to providers and diligently overseeing credentialing and enrollment for all payers.

Just last week we heard of a national billing and data hosting firm offering to manage provider maintenance (i.e., making certain provider data is current/accurate) for $5/month vs. our higher rate. The old saying “if it seems to good to be true...” seems relevant here.

Listen, health centers focus on taking care of patients and their communities. Their Hedgehog Concept (and mission statements) focus on that.  Billing or data hosting companies focus on, well, billing or data hosting. Credentialing and enrollment firms... especially those targeted to a specific vertical like health centers... they can truly best in the world.

We know we won’t get every contract and want competition. It makes us all better. AND, we are every day working on improving all we do around credentialing and enrollment. Ultimately, that is the point. We can afford our total focus, attention, and resources to be around mastering health center credentialing and enrollment. A health center, billing company, or data hosting firm will never be able to do that.

Contact us today to learn how we can help your team master credentialing and enrollment.