Getting credentialed with the right insurance panels is a key to growing your practice revenue. However, the credentialing process can be a daunting task. Are you aware that a Medicare application is a minimum of 30 pages for a solo provider and may surpass 50+ pages if you are a corporation or group practice? Even a single mistake in the credentialing application process may delay your acceptance and affect your cash flow. Hence, you have to understand how to do it correctly or find someone who can do it for you, like outsourcing the credentialing process so as to keep the cash flow going and maintain a healthy Revenue Cycle Management (RCM) process. - See more at: http://www.medicalbillersandcoders.com/blog/credentialing-process-for-optometry-practices.html#sthash.yjNr7lqR.dpuf

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Credentialing Process for Optometry Practices
In order to enhance your revenue, credentialing is an important part of Optometry
Getting credentialed with the right insurance panels is a key to growing your practice revenue. However, the
credentialing process can be a daunting task. Are you aware that a Medicare application is a minimum of 30 pages
for a solo provider and may surpass 50+ pages if you are a corporation or group practice? Even a single mistake in
the credentialing application process may delay your acceptance and affect your cash flow. Hence, you have to
understand how to do it correctly or find someone who can do it for you, like outsourcing the credentialing process
so as to keep the cash flow going and maintain a healthy Revenue Cycle Management (RCM) process.
Optometry, part of the highly specialized medical community, although historically had never acknowledged the
credentialing process, has of the recent past, found the need to employ the credentialing process, in line with other
third party payers, so as to provide proper patient care and management. It was only after 2010, that the
credentialing committees at the Joint Commission (JC) accredited facilities began credentialing optometrists
certified by ABCMO as specialists in medical optometry. Moreover, with the new payment models that have been
introduced along with Value Performance Fee system, and the referral system, credentialing of your optometry
practice is a must. If at any time you are required to apply to a JC accredited medical Facility, then you will need to
be credentialed. Credentialed Optometrists are now part of the Medicare Physicians by the Centers for Medicare
and Medicaid for billing and other purposes. Approximately 85 percent of US medical facilities are accredited by the
Joint Commission and its accreditation is the “gold standard” and a prerequisite for Medicare-Medicaid participation
and billing.
Although the credentialing process for optometry is very complicated, here are some essentials that you need to be
aware of if you do it yourself or if outsourcing to a third party vendor.
 Type of Practice: You as an Optometrist need to choose the type of practice - solo, small independent group
practice or large group, part of a Managed Service Organization (MSO), as each has its own advantages and
risks. So due diligence and meticulous planning is required as this could affect the Revenue Cycle
Management of your practice, once you are credentialed under a certain Level

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 Specialty: When initiating Credentialing you need to determine whether you wish to be credentialed as a
general practitioner, specialist or sub-specialist. When seeking appointment at a JC accredited health facility,
an ABCMO certified optometrist can be credentialed and privileged as a general practitioner of optometry or
a specialist board certified in medical optometry
 Place of Practice: Determining where you practice also makes a big difference to the way your optometrist
practice will be coded and billed and make revenues. Obtaining hospital Privileges has its advantages. Given
the changing healthcare reforms, rules & regulations, and as under the Obamacare Act, which has pulled in
many more footfalls, elderly patients will need access to optometrists either in their offices, in long-term
care facilities, at home, and, yes, even in hospitals. Hospitals will now play an important role in future health
care delivery and optometrists must continue to seek and be granted hospital privileges and for this
credentialing is a must.
 Qualifications & Licenses: You will be screened for your professional training and identified for the range of
optometric services you can deliver. During the credentialing process, optometrists are often asked to
submit information on education and professional background, current licensure to practice optometry,
Drug Enforcement Agency license (if applicable) and applicable certificates to dispense controlled
substances or therapeutic agents. All optometrists need to demonstrate a valid license with no pending
quality of care complaints. This is verified with each respective State Board of Optometry or the AMA for
MD's and the National Practitioner Data Bank – along and lengthy process but has its long term benefits
 Re-Credentialing: Do note that the re-credentialing process occurs every three years. This entails evaluation
of the provider’s performance, and includes any complaints on-going or adjudicated during the year. There
are also re-verification of credentialing documents such as the professional license professional, liability
insurance, DEA registration certificate, and other applicable documents. Respective State Boards of
Optometry are queried concerning any adverse actions against the license of the provider.
Those optometrists who cannot demonstrate compliance with or adherence to the credentialing, performance and
practice standards usually do not obtain the credential stamp. Optometrists can also find it difficult to be retained
within a provider network without being credentialed. As an Optometrist, during the credentialing process you need
to have adequate professional liability insurance & be free of any malpractice claims. Any of the above can affect
your reimbursements affecting your RCM process. So to put together all the documentation and accreditations &
licenses, if you wish to be part of the CMS billing and coding system, to enhance your revenue, credentialing your
practice is very essential.