Medical Credentialing and Other Steps to Joining Workers’ Comp Networks

November 28th, 2017 - By Matt Garnese

Getting your practice properly vetted through medical credentialing practices is a necessary step for all medical specialties, and in Occupational and Environmental Medicine, this is the primary means by which you can join Workers’ Compensation Networks, such as a Preferred Provider Organization (PPO), or an Exclusive Provider Organization (EPO).

In a recent series of articles published by Claims Journal, Gregory Moore, the chief commercial officer of CLARA analytics discusses the role of PPOs in Workers’ Compensation, and emphasizes the importance of quality in healthcare outcomes to reducing costs for payers: “Over the past decade, outcomes-based networks have become a well-adapted and proven model for dramatically improving a claim population’s overall costs, lost-time and litigation.” The article describes some key points for what an insurer looks for when evaluating doctors for PPOs. The following are some useful concepts when setting up your Occupational Medicine practice.

Related: The Importance of Medical Credentialing ROI

Medical Credentialing Contributes To Lower Healthcare Costs

For the insurer, credentialing your practice is more than a formal requirement. It is a necessary step in demonstrating that your practice meets the proper standards in providing care to join the network. In part one of his series for Claims Journal, Gary Moore says, “A perfect PPO would include 100 percent of doctors who pass the base qualifications of credentialing.”

Networks deliver a wide variety of different medical providers from which workers can choose, which allows for discounted medical services. This system, however, does not exclusively account for the quality of services rendered and therefore can lead to higher costs in the long term for payers. While the minimum requirement for joining certain Workers’ Compensation networks is simply getting credentialed, the quality of care that you provide will lower costs demonstrate the value of your services.

Also Read: Medical Credentialing Tips and Best Practices

A piece of advice that Gary has for insurers and employers is an important one to remember when running your medical practice: “Network savings are the shiny object that distracts from the difference in total costs…quality at a higher price point can significantly outpace discounts when you look at the total cost of a patient in any market.”

Given that payers in Workers’ Compensation are looking for a balance between the quantity of providers and quality of medical services, it behooves you as a physician to find ways to innovate and focus on the highest quality of care possible such as through the use of Electronic Health Records software, especially Occupational Medicine EHR. That way your practice will be more likely to be chosen in an EPO, for example, and receive even more Workers’ Compensation patients.

Medical Credentialing Services and Occupational EHR Software

PrognoCIS can help you with your provider enrollment, affiliating your practice with insurance companies to receive your third-party reimbursement for medical services. Our credentialing team can help organize and maintain the necessary documents to open your Occupational Medical practice. In a recent PrognoCIS webinar▶️, “The Dos and Don’ts of Medical Credentialing,” we discuss tips and best practice for getting your practice credentialed. If you are interested in our credentialing services, don’t hesitate to contact us here.

PrognoCIS Occupational EHR software helps many of today’s leading occupational medicine companies improve client productivity and lower medical costs. With digital OSHA forms, instant testing for drug and alcohol use, as well as Workers’ Compensation reports all available in the EHR, PrognoCIS accelerates your occupational medicine workflow. Using EHR software, you can have higher quality encounters with satisfied patients at a lower cost.

We urge all of you who are setting up occupational medicine practices or looking to innovate how you provide health care, to explore your EHR software can help improve the quality of medical outcomes in your practice.

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