At 1ˢᵗ Credentialing we know that when our clients place their trust in us, we take that responsibility seriously by communicating with our clients to create a transparent and collaborative partnership.
Healthcare organizations of every size realize that hiring 1ˢᵗ Credentialing is the most economical and efficient way to solve their credentialing needs. We have the training, expertise and commitment it takes to keep a complex process moving forward at all times.
1ˢᵗ Credentialing supports healthcare practices of all sizes - from health systems, to community hospitals, to large group practices, to smaller organizations. We help get your providers up and practicing as fast as possible.
Learning more about the credentialing process benefits us and our clients. 1ˢᵗ Credentialing offers regular videos and newsletter updates to bring our clients and those interested in innovations in credentialing up to speed.
More Focused CMS Audits Will Reduce Burden on Accurate Claims Processors
In an effort to reduce the burden on those claims processors who submit claims correctly, the Centers for Medicare and Medicaid Services (CMS) recently announced that it will target those providers and suppliers that have high error rates.
CMS is directing its Medicare Administrative Contractors to focus medical reviews on specific providers and suppliers within a service, instead of all providers and suppliers that are billing a particular service.
New Audit Process Targets Those with High Claim Error Rates
The new Targeted Probe and Educate pilot will select claims for services and items that present the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate.
Under the prior process, the first round of reviews included all providers who deliver a specific service. The new changed claim selection procedure is more provider- and supplier-specific, and those who are already submitting compliant claims will have a reduced audit risk.
After 3 rounds of review, providers and suppliers that continue to have high error rates may be subject to additional actions. These can include 100% prepay review or referral to a recovery auditor. After demonstrating sufficient improvement or low error rates, the targeted providers and suppliers may be removed from the review process.
The original Targeted Probe and Educate program was launched by CMS in 2014 in an effort help reduce errors in the claims submission process. So far, CMS acknowledges that the program is a success due to the decrease in the number of claim errors after providers receive education and guidance.
You can read more about Targeted Probe and Educate medical reviews here.
Let Us Manage All Your Payer Enrollment Services
If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.
Our credentialing experts are here to help you assess exactly which solutions you need and let you know how inexpensively we could put you on the right track. 1ˢᵗ Credentialing includes primary source verification and payor enrollment for all insurance networks including Medicare, Medicaid, Medi-Cal and insurance networks. Don’t wait another minute, contact our terrific team today!