Credentialing can be almost as complicated as medical school it seems. There are physicians who can perform complex surgeries and even transplants, but can’t seem to get a grasp on credentialing. Credentialing is very similar to learning a new language. There are many intricacies and often times, the meanings of certain things can be plural or even ambiguous. Credentialing for an Independent Diagnostic Testing Facility can be even more of a challenge. If you aren’t sure what an Independent Diagnostic Testing Facility (IDTF) is, here are a few examples: Sleep Labs, EEG Providers (who are not also a physician providing this service in their office), Laboratories including drug testing providers, and cardiac event monitoring companies. While this isn’t a comprehensive list, it does cover the most common types of IDTF’s.
Credentialing for an IDTF is a tremendous undertaking and often takes longer than it would to credential a physician or group practice. Hiring a credentialing company who understands the differences between an IDTF and an independent practice is imperative to quickly getting your business credentialed. Not only does Medicare have its own guidelines for IDTF’s but most commercial carriers also have their own set of guidelines. No two carriers are the same.
I often get called by a facility who will tell me that they are an IDTF, trying to fill out a commercial insurance application, but have been unsuccessful in submitting the application because it keeps getting denied due to a missing CAQH number. As most of you who own an IDTF know, you will never have a CAQH number. This is because the CAQH database only applies to individual providers. CAQH does not have a process to house information for IDTF facilities. If you are trying to do your own credentialing, you can go round and round with this sort of dilemma. As a Practice Consultant, I always advise an IDTF to never do their own credentialing. There are just too many moving parts for an IDTF to try and credential themselves. The CAQH dilemma is just one of the hurdles you’ll have to jump through to credential your IDTF.
Often, payors will require an IDTF site inspection before they will allow them into their network. These site inspections can be daunting and last all day. If you don’t have your policies and procedures and procedural safeguards in place you may very well fail inspection. Allowing a qualified credentialing company to review your documents and advise you before the site inspection will always yield a greater chance of passing inspection. For an IDTF who is just starting out (and does not have these documents already), you will want to hire a credentialing company to assist you in creating these documents so you may begin the credentialing process.
These are just two of the major hurdles in front of any IDTF who is seeking payor credentialing. I cannot stress enough the importance of contacting a reputable credentialing company who can help with these hurdles as well as all the other aspects of credentialing an IDTF. When you contact the company be sure to ask for references of other IDTFs that they have helped. Ask them how often they contract to perform services for IDTFs and ask them anything else that makes you feel comfortable. Just be sure they truly are experts in the field of IDTF credentialing before you hire them.
Cynthia Young, the former CEO of STAT, which is a national billing, credentialing and practice management consultant. STAT is a U.S.-based, national provider of credentialing, payor enrollment, rate negotiation, and other credentialing related services.