M&R Healthcare Consultants have decades of industry experience in Financial, Operational and Revenue cycle Management, Credentialing, Grants and Patient Advocacy

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Credentialing
  • GAP Analysis – Full review of a credentialing department structure, policies and procedures to identify any gaps in compliance and to provide a strategy to mitigate risk.
  • Complete Department Stand-up:
  • Hiring Top Credentialing Talent: We assist in finding and recruiting the best professionals for your credentialing team.
  • Department Formation: Guidance on setting up the structure and workflow of your new credentialing department.
  • Credentialing Software and Processes: Recommendations and implementation of the best software and processes to streamline credentialing.
  • Policy Language Development: Creation of clear and effective credentialing policies.
  • Accreditation and Compliance: Ensuring your credentialing processes meet all necessary accreditation standards and compliance requirements.
  • Complaince Auditing: At M&R Healthcare Consulting Services, LLC, we offer comprehensive compliance auditing services to ensure your credentialing processes meet all regulatory and accreditation standards. Our expert team conducts thorough reviews of your current practices, identifies areas of improvement, and provides actionable recommendations to enhance compliance. We help you maintain accurate and up-to-date credentialing records, ensuring your organization remains compliant with industry regulations and standards. Trust us to help you navigate the complexities of credentialing compliance with ease and confidence.
  • Provider Education on Credentialing: At M&R Healthcare Consulting Services, LLC, we educate groups or individual providers on the importance of credentialing, compliance standards, and payor contracting/enrollment. Our comprehensive training also covers how these elements impact the overall revenue cycle, ensuring providers understand the critical role credentialing plays in their practice's financial health.
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Credentialing FAQ

Primary Source Verification
Primary source verification is a crucial process in credentialing that confirms a physician’s education, training, and certifications are authentic and current. This ensures the qualifications and competencies of the physician are valid and meet established standards.
Exclusive Checks
Exclusion checks are an essential part of credentialing that verify a physician is not listed on government or industry exclusion lists due to prior malpractice history. This process helps ensure the physician’s credibility and compliance with legal and industry standards
Payor Enrollement
Payer enrollments in credentialing involve the process of getting a physician or healthcare provider approved to offer services to patients covered by various insurance plans. This ensures that the provider is included in the networks of different health insurance companies, allowing them to be reimbursed for services rendered to insured patients.
Privileging
Privileging is the process in credentialing that grants a physician the authority to perform specific procedures and deliver certain types of patient care based on their verified qualifications, skills, and experience. It ensures that healthcare providers are permitted to carry out the clinical tasks they are competent to perform within a healthcare facility.
Recredentialing
Recredentialing is the periodic review and reassessment of a healthcare provider's credentials and qualifications after the initial credentialing process. It typically occurs every few years as required by accrediting bodies, health plans, or healthcare organizations. The purpose of recredentialing is to ensure that healthcare providers maintain current licensure, certifications, skills, and competencies, and continue to meet the standards necessary to provide safe and effective care to patients. This process helps maintain the quality and integrity of the credentialing system over time.

The risk of not credentialing providers

Failing to credential medical providers exposes your organization to legal risks related to providing substandard care. The Office of Inspector General for the Department of Health and Human Services maintains a list of individuals and entities excluded from federally funded healthcare programs, including those convicted of Medicare or Medicaid fraud. This underscores the importance of thorough credentialing processes to ensure providers meet regulatory standards and mitigate legal and compliance risks.

How long does credentialing take

For new providers joining your organization, the process can take between 120 to 180 days to complete. This timeline includes performing necessary verifications such as primary source verification of credentials, submitting provider information to various payors with whom your organization has agreements, and obtaining an effective date for the provider to begin offering services and receiving reimbursements from those payors. This timeframe ensures that all required steps in the credentialing and payer enrollment process are meticulously completed to comply with regulatory and contractual obligations.
  • Credentialing Intake Form
Do you employ or contract prescribers who require a DEA certification?
Do your providers require hospital privileges with local hospitals?
Are providers currently enrolled in all payor agreements under the groups tax id?
I am interested in the following Credentialing & Enrollment services: (Please add the following applicable services in the "service(s) requesting" field)● Initial credentialing of newly hired providers (licensure review, background check, education verification, sanctions review)● Re-credentialing of existing providers (re-review of licensure and sanctions required at 3 year intervals)● Hospital privileging (both initial application & reapplications)● DEA certification services (both initial application & renewals)● Commercial enrollments completed (HMO, PPO, EPO) - Initial application and Renewals● Government enrollments (Medicare, Medicaid) - Initial application and Renewals● CAQH profile services (both initial creation & maintenance)● Formation of Credentialing Policies & Procedures