Today we are discussing the financial foundation of an office-based provider. For clarity, we define an office-based provider as performing non-emergency, elective-based services.

With office-based providers, we consistently see 2 overlooked components of their business:

  1. Credentialing
  2. Investing in a qualified front office

Credentialing: for many office-based providers, volume comes from referrals from other doctors. Primary care physicians are not motivated to refer their patients to providers that are out of network, as the patients would pay a higher out-of-pocket cost. If an office-based provider plans on staying in business, being in network with high-volume insurance carriers is crucial. (Note: the decision for a doctor to be in or out of network should be made on a case by case basis and with the help of someone who knows the business of insurance credentialing.)

Investing in a qualified front office may seem like common sense, but it is often overlooked. The mistakes of the front office cost providers tens of thousands of dollars each year. Finding and employing professionals for patient scheduling, verifying benefits, authorizations, and PCP referrals is critical to the finances of an office-based provider. The reimbursement process starts at the front office and if that is strong, reimbursement is both more likely and timely. If they are not strong, inexperienced or uninformed staff can void reimbursement before the pay cycle even begins.

At MediMobile, we build tools to capture charges and data because reimbursement depends on proper documentation. However, without verifying the true benefits of each patient and following those guidelines, doctors may not be reimbursed. The front office must make sure you will be paid before the patient ever walks into the office.

If you have questions, please don’t hesitate to contact us. Also, if you’re an office-based provider in need of consulting services, we will connect you to healthcare experts specializing in your business model.