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Medical Coding

At 360 Provider Solution, we are dedicated to delivering unwavering quality in our services, allowing you to focus on what truly matters—providing exceptional care to your patients. As a leading medical billing firm, we strive for perfection and are committed to meeting the needs of healthcare professionals by offering accurate and comprehensive coding services.

Our offerings include:

  • Charge Review/CPT Code Review: Ensuring that all charges and CPT codes are accurately reviewed and appropriately billed.

  • Notes Review: Meticulous examination of clinical notes to ensure they support the coding and billing process.

  • Compliance with CMS Guidelines: Adhering strictly to CMS guidelines to ensure compliance and avoid potential issues with claims.

We aim to be your trusted partner in medical billing, helping you navigate the complexities of the industry with precision and care.

Types of Credentialing

Provider Credentialing – Individual Provider Credentialing

Individual Provider Credentialing involves verifying and validating the qualifications and credentials of a healthcare provider, such as a physician, before they can bill and offer services within a healthcare network or through insurance companies. This process is vital to confirm that the provider meets all necessary standards and requirements for delivering medical services and obtaining reimbursements.

Facility Credentialing – Facility or Group Credentialing

Healthcare providers and facilities must undergo various types of credentialing to ensure they meet the necessary standards for delivering medical services and receiving reimbursements. These include:

Facility or Group Credentialing entails verifying the qualifications and credentials of a healthcare facility or group, such as a hospital or medical practice. This process ensures that the facility meets the required standards for providing medical services and receiving reimbursements from insurance companies. It is crucial for maintaining quality care and financial stability within the healthcare sector.

Credentialing Process with 360 Provider Solution

1 . Collecting

At 360 Provider Solution, we understand the complexities and time-consuming nature of the credentialing process. That's why we offer comprehensive credentialing services for individual providers, groups, facilities, hospitals, and other medical establishments. Our credentialing experts can assist you with:

Gathering and completing all necessary paperwork and applications.

  • Submitting Enrollment Applications: We handle enrollment applications for all payers across all states.

  • State Credentialing: We can help you credential or get enrolled in any state.

  • Licensing Services: Assistance with obtaining and maintaining necessary licenses.

  • Demographic Updates/Changes: We manage updates and changes to provider information.

  • NPI Application: Support in applying for individual or group National Provider Identifiers (NPI).

  • EDI/ERA/EFT Setup: We can assist with setting up Electronic Data Interchange (EDI), Electronic Remittance Advice (ERA), and Electronic Funds Transfer (EFT).

  • Provider Enrollment: Adding or enrolling new providers in a group.

  • Recredentialing: Managing the recredentialing process to ensure continued compliance.

3 . Follow- up
2 . Verifying

Verifying your credentials with insurance companies and other third-party payers.

Regularly following up with payers to ensure the credentialing process is completed promptly.

Importance of Credentialing in Medical Billing Efficiency

Credentialing is essential in medical billing as it validates a provider's or facility's authority to treat, accept, and attend to patients across various insurance payers. The advantages of being credentialed or in-network with insurance include:

  • Increased Revenue: Attract more patients and experience faster claim processing, leading to higher revenue.

  • Negotiated Fee Schedules: Benefit from negotiated fee schedules that enhance your revenue potential.

  • Reduced Denials: Minimize claim denials and speed up the billing cycle, ensuring quicker payments.

  • Expanded Patient Base: Credentialing allows you to increase the number of patients you can serve.

Common Challenges in the Credentialing Process

Missing or Incomplete Paper Work

Navigating the credentialing process can be challenging for healthcare practitioners and institutions. If you need assistance, 360 Provider Solution has credentialing experts on staff to guide you through the process and help you meet all deadlines.
Some of the common difficulties encountered during the credentialing process include:

Delays in Credentialing Process
Lack of Knowledge about the Credentialing Process

Here's what our customers say

Managing a busy medical practice requires a reliable billing partner, and 360 Provider Solutions has proven to be exceptional. Their accurate coding, clear reporting, and tailored service have exceeded my expectations. It’s comforting to know that our billing processes are in capable hands with them.”

- John L
Physician

Partnering with 360 Provider Solutions has revolutionized our clinic’s operations. Their meticulous approach to medical billing is unmatched. The team’s expertise and dedication to precision have significantly boosted our revenue. I highly recommend their services to any healthcare practice seeking a dependable billing solution.

- Brian Moten
Clinic Manager

Frequently asked questions

How does credentialing differ from privileging?

Credentialing and privileging are related but distinct processes. Credentialing involves validating a healthcare provider’s qualifications, while privileging grants specific clinical privileges within a healthcare setting based on those credentials.

How can accurate medical coding increase profits for healthcare facilities?

Accurate medical coding directly impacts the financial health of healthcare organizations. By correctly assigning codes, facilities can ensure accurate billing, leading to proper reimbursement and increased revenue for services provided.

How often should I update my credentials with insurances?

It’s essential to keep your insurance qualifications up-to-date. If there are changes to your licenses, certificates, contact information, malpractice history, or other relevant details, promptly notify 360 Provider Solution to ensure your credentials remain current.

Where can I file a complaint or provide suggestions about 360 Provider Solution's credentialing procedures?

360 Provider Solution welcomes feedback on its credentialing procedures. You can submit complaints or suggestions through our dedicated support channels to help us improve our services.

Does denial management only apply to hospitals and large healthcare providers?

No, denial management is crucial for all healthcare providers, regardless of size. 360 Provider Solution assists by conducting routine coding audits and ensuring adherence to coding standards to reduce the risk of claim denials.

In addition to medical coding, what other services does 360 Provider Solution offer?

360 Provider Solution offers a comprehensive range of services beyond medical coding, including medical billing, revenue cycle management, consulting, training for healthcare administrators, and enhanced documentation services.

How does 360 Provider Solution ensure accuracy in medical billing?

At 360 Provider Solution, we prioritize quality assurance through continuous training and regular assessments of our experienced coders. We also conduct internal audits and peer reviews to maintain the highest standards of accuracy in our billing processes.

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Dedicated partner in medical practice management, offering comprehensive insurance credentialing