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Medical Billing Plans

As an owner of a private practice, you clearly understand the importance of personalized medical billing plans. However, managing the entire RCM process, including the provider credentialing process, can become daunting. Credentialing in medical billing is critical to a practice’s financial management and thus necessitates knowledge/expertise and attention to detail. Outsourcing your entire RCM process can be a low-cost alternative, which lets you and your staff focus more on offering exceptional patient care.
Let’s explore customized patient medical billing plans – shedding light on tailored approaches to medical billing and enrollment in healthcare for providers.

Personalization Medical Billing Plans

Patient billing customization is adapting medical billing services to match healthcare practitioners’ specific and individual demands. A third-party billing company must recognize that every healthcare physician has a set of unique needs and requirements. Thus, providing personalized options helps improve efficiency and practice revenue. Patient billing personalization facilitates physicians’ ability to opt for services and medical billing plans that best meet their needs. It could range from full-service billing to specialized billing attributes/tasks, including claims submissions or payment posting.
Why do healthcare providers need customization?
Through customization of services, healthcare physicians can ensure that their RCM procedures are compliant (with proper provider credentialing), efficient, and precise. Professional billing companies like Physicians Revenue Group, Inc. collaborate directly with healthcare providers to create custom medical billing plans that suit their specific needs and maximize practice revenue.

Medical Billing Plans for Private Practices

Medical billing is intricate owing to varying requirements linked to different specialties, insurance providers, and local/federal regulations. Standard billing solutions are not sufficient to address the needs of private practices. It is where custom medical billing plans come into play; such plans from professional third-party billing companies are customized to fit a practice’s spatiality, size, needs, patient volume, and reimbursement processes. Professional billing partners ensure that all claims are submitted accurately, denials are reduced, and reimbursements are processed faster.
Below is how customized medical billing plans can be tailored to the needs of private medical practices:

Effective Claims Management

The timely and prompt claims reimbursements are essential for a consistent revenue model. Personalized billing plans come with an efficient claims management system that tracks and manages claims and identifies the hindrances that cause rejections, delays, and denials. Effective claims management ensures swift processing of claims, leading to timely reimbursements.

Insurance Network Integration

Working in collaboration with insurance providers is an essential aspect of any private practice. Custom medical billing plans offer seamless insurance network integration. It also simplifies the process of claim submission, processing, and follow-ups for efficient reimbursements. The custom billing plans eliminate the need for manual submissions and claims processing by the private practice.

Specialty-specific Custom Solutions

Specialty-specific operations of private practices necessitate specialty-specific solutions. Custom solutions offer personalized medical billing plans, which consider the specific procedures, codes, and coding modifiers that correlate to a practice’s specialty. It not only ensures accurate and error-free billing but also works to minimize the chances of rejections and denials.

Compliance to Regulations

Ensuring absolute compliance with the regulations from the regulatory authorities is yet another essential aspect of a healthcare practice. Customized medical billing plans help you comply with all specific regulations by focusing on the regulatory part of your specialty-specific practice. Doing so can help avoid revenue loss due to penalties and fines – thus improving a practice’s reputation. That brings us to:

Medical Provider Credentialing

Credentialing in medical billing is a process of confirming a healthcare provider’s experience, training, education, and competence to ensure they meet all patient care requirements. The main goal of proper enrollment in healthcare is to ensure that all healthcare workers are certified to offer top-quality care and lower malpractice risks.
All medical providers must register with Medicare and have an NPI (National Provider Identifier) number to participate in the Medicare program. For enrolling, all healthcare providers must complete an application that details their education, training, and experience. Furthermore, to participate in a Medicaid program, medical providers must register with their state Medicaid agency and verify their credentials.

Medical Credentialing Types

There are multiple types of provider credentialing, and these include:

Initial Credentialing

The initial credentialing verifies the qualifications and background of new healthcare providers before they begin practicing.


The re-credentialing process is verifying a healthcare provider’s history and qualifications every few years to ensure they meet the industry standards.

Provisional Credentialing

The provisional credentialing process involves providing temporary credentials for healthcare providers who are new to a practice/organization.

Outsourcing Provider Credentialing

The credentialing software is expensive, which makes it out of reach for many smaller practices. While the software is limited to tracking features, most users still complain that the software is complex to figure out. Most users also fail to set it up correctly and miss the re-credentialing widow.

Some billing provider companies offer credentialing as an add-on, but credentialing might not be their primary business. They might also not have the in-house expertise of a dedicated credentialing provider.
On the other hand, a specialized credentialing service focuses entirely on credentialing – like the Physicians Revenue Group, Inc. Our employees are experts and give providers tools to streamline their submission processes. Documentation is stored in the secure, HIPAA-compliant data repository. It works alongside all payers in all states of the USA, with experience with all specialties.

Why Outsource Credentialing Services?

Reputable service providers will conduct the payer discovery calls as their first item of business for a client, checking the provider’s credentialing status. These classes are made separately for each payer and provider. The staff typically waits on hold for at least 50 minutes to get through a payer – which is something that provider practice staffers can’t do. Professional credentialing services like PRG notify clients when their re-credentialing dates approach so the deadlines are never missed.


To summarize, personalized medical billing plans are crucial for private practices. They help manage finances better. Outsourcing this process can save time and money, letting you focus on patient care. Custom plans fit the unique needs of each practice, making billing smoother. It’s like having a tailor-made suit—it fits perfectly. Furthermore, outsourcing the critical process of provider credentialing to specialized services, like Physicians Revenue Group, Inc., offers expertise that surpasses generic solutions. So, think about how these personalized plans and outsourcing credentialing can improve your practice and earn more.

Frequently Asked Questions

Practices that want to bill an insurance provider need to get themselves credentialed. Such institutions include clinics, hospitals, physicians, dentists, physical/behavioral health therapists, social workers, and more.
Provider credentialing is similar to a job application; it is how insurance providers verify medical providers’ qualifications and legitimacy to receive reimbursements for services. When providers are credentialed with specific payers, they get to bill the payer directly and get timely reimbursements.
Both are different and separate steps, in which credentialing comes first. After credentialing, the practice can enroll with a clearinghouse to electronically submit claims.