Medical Practice Management Blog

MBA Medical Business Associates stays on top of the constant changes in technology, law, & information that affects your medical practice & the healthcare industry. Check our medical practice management blog here for updates.
A doctor speaks to a mother and her child.

Credentialing & Contracting for New Medical Service Providers

 The path to working and getting accepted into an insurance carrier’s network as a medical service provider involves a very thorough vetting process called credentialing. This is used by insurance carriers, facilities and hospitals to determine whether a medical provider meets all the necessary standards to participate in said network (Contracting). Nowadays, being in network is critical for many practices. Reason being, the rise in people being enrolled in health coverage means their provider needs to accept their insurance. If you aren’t credentialed—or, in a prospective patient’s network (Contracting)—they are very likely to go to a competing practice and save on potential out-of-pocket costs.

 How does the credentialing process work?

Before a physician can participate in particular networks, these requirements need to be passed:
  • Reviewing past education
  • Medical licensure
  • State and federal registrations and certifications
  • Professional liability coverage
  • Residency programs completed
  • References from colleagues and past professors
As you can imagine, this can be quite a time consuming procedure. If you are doing it yourself, the process can take between 3-4 months in order to submit all necessary paperwork and documentation, as well as following up and corresponding with insurance departments. Once credentialing is complete, it takes up to another 3 months to contract.

How can you make credentialing quicker?

  • Plan in advance. Remember, this process could take months. It’s important to start as early as possible. Some practices will start submitting credentialing information as soon as they have a hire date for their new physician.
  • Use your resources wisely. Some practices use in-house staff to manage credentialing. Given the scope of credentialing, it often falls beyond the capabilities of your typical medical staff. Thus, they’ll seek third parties to facilitate the process.There’s also the process of re-credentialing, for which you’d need employees who are constantly updating and monitoring the information to make the next go-around much smoother.

How to get started on your credentialing

A doctor speaks to a mother and her child.Fortunately, many software programs and services exist which can greatly expedite credentialing. They’re often provided at no cost and can save a great deal in terms of time and paperwork. Along with a state credentialing application, physicians will use CAQH ProView, a fast and secure way of submitting credentialing information. It’s also the most widely used credentialing database (we must note, do not leave any data entry boxes blank – this could lead to forms being rejected). Once you’re finished submitting your information, the insurance company will begin the credentialing process. If credentialing frustrates you, please know you aren’t alone. It’s a very time-consuming process. It is absolutely critical for the success of your practice, though, so please do your diligence and make sure you get fully credentialed & contracted. If you have any questions at all, please contact the staff at MBA Medical.

Top Trends in Healthcare, Now and in the Near-Future

It’s been a time of upheaval in healthcare. Today is a far different, almost entirely new, industry than what existed simply ten years ago. The transition to ICD-10, widespread adoption of electronic health records, sophistication of data science… all of these are monumental shifts, and they’ve happened quickly and recently.

So quick, in fact, it has become almost impossible to stay on top of emerging trends and technologies. Things are happening though that will have a bottom-line impact on your practice, and we want you to stay ahead of the curve.

mba personalized med

The New World of Personalized Medicine

A woman was diagnosed with lung cancer in 2002, which later spread to her brain. She was 44, a vegetarian and had never smoked. Things looked grim, to say the least. She was introduced to a drug called getfitinib, which was created as a “genetic smart weapon” to combat more specific mutations.

As a result, she is still alive today.

This story highlights the early stages of personalized medicine, the practice of tailoring treatment and prevention based on the individual’s needs. This is different from how things have been done traditionally, which doctors describe as being a “one-size-fits-all” mindset. Someone has “brain cancer”, and they’re given treatment that has been successful for most people with brain cancer.

But we’re not all the same, are we?

The human genome has 3 billion lines of code. The scope of this was wonderfully illustrated by author Siddharta Mukherjee. He says if we were to see the genome in actual ‘book form’, it would comprise 66 full sets of the Encyclopedia Brittanica.

That means one person’s melanoma can be far different from another’s. According to Jackson Laboratory, an independent, nonprofit biomedical research center, if you have cancer today, you have a 35% chance of receiving the correct form of chemotherapy the first time.

When treating, doctors currently rely on someone’s profile – their age, weight, gender and family history. That, as well as the testimony of the patient. From there, they make their most informed decision.

Within the world of personalized medicine, this could be considered “guesswork”. It’s not perfect, but it’s the best we have.

A Very Basic Primer on What Genes Are

First, we must differentiate between the gene and the genome. The gene, whose definition has changed over years, is essentially a unit of biological information. The genome, to use Dr. Mukherjee’s metaphor, is the encyclopedia that contains all of the genes.

Genomes are made of DNA, the molecule that carries genetic instructions for all living organisms. DNA contains four basic building blocks: adenine (A), cytosine (C), guanine (G) and thymine (T). The sequence of these blocks—arranged in fours, like ACTG, GCTA, etc.—is what forms the instructions in the genome – it’s what distinguishes you from him.

Here’s what personalized medicine will make us capable of:

Among that roomful of 66 encyclopedia sets, for which each set contains 44 million words across 32 volumes, genomic mapping has allowed researchers to isolate not just the particular book, not just the page, but the exact word within this series, and to study how it influences who we are.

Meaning, in your body, among the three billion lines of code, genomic mapping can find and examine one tiny, four-letter sequence.

Now, imagine you’re seeing your physician. Your genome is sequenced and then analyzed. In this analysis, you see a list of diseases you may be at risk for, as well as your likely response to common drugs. You’ll see gene variants in your family, like ones for kidney diseases and sudden death. You’ll also see variants that are in your family but have not been discovered. This can determine the entire course of your healthcare.

Jackson Laboratory, as mentioned above, asked a clinician, “If there was one piece of information you had that would change the way you treat patients every day, what would it be?”

The reply: “If I could know which of those patients will eventually develop leukemia, it would change the way I treat them today.”

Medicine has for too long been in the ‘reactive position’ – waiting for disease to manifest before treatment is available. Again, that’s the best option we’ve had.

Instead, patients will be evaluated for the risk of disease, and treated accordingly. It’s like the science-fiction film Minority Report, but for healthcare.

We’re not there yet, though we are well on the way. It’s far from being mainstream, still costly and in the stages of further development. Something to consider, though – the Human Genome Project took 13 years and $3billion to complete. Now, researchers can sequence a genome overnight.

In the very near future, we will look at our current diagnosing and treatment methods in healthcare and describe them as “primitive”. This is natural – when new technology arrives, we often look at it’s predecessor and wonder, “how did we ever survive?” And the answer is always the same – it’s just what we had at the time.

Contact us if you have any questions on personalized medicine, and the implications it may have on the medical industry.


What Makes a Great Medical Biller?

It can be so difficult to find a good medical billing professional. As a physician, you know how critical a skilled medical biller is to your cash flow. They are the bloodline to your business.

If you’re lucky, you have a biller who’s been with you for decades – they know your practice, your methods of testing, and the two of you can communicate frequently and clearly.

Missing Appointments for Medical Billing

How Do I Bill for a Missed Appointment?

Have you found that more and more patients are missing appointments? Are you unsure of how to address this issue? When patients do not come to their appointments, it not only causes inefficiency to the overall operations of the office, but it can cause significant interruptions to the scheduling process and can be a financial drain. Here are some ways to address patient no-shows.

Guide: Accountable Care Organizations

Click here to download our Guide: "How Independent Practices Can Succeed in a Healthcare Industry Shaped by ACO Programs". If you would like more information you can Request a consultation.

Practice Management

  • Anesthesia Billing
  • Full-service medical billing
  • Patient account management
  • Encounter form design
  • Patient balance collections
  • Learn More

MBA In The News

Guide: Accountable Care Organizations

Click here to download our Guide: "How Independent Practices Can Succeed in a Healthcare Industry Shaped by ACO Programs". If you would like more information you can Request a consultation.

Practice Management

  • Anesthesia Billing
  • Full-service medical billing
  • Patient account management
  • Encounter form design
  • Patient balance collections
  • Learn More

MBA In The News


MBA Medical Billing Services, Inc.
P.O. Box 821350
Vancouver, WA 98682

866-622-2455 Toll-free
360-687-5221 Vancouver, WA

Contact Us


Make A Payment