A Guide to Credentialing for New Physical Therapy Owners

Starting a new physical therapy practice is like embarking on an exciting, uncharted adventure. Before you can guide your patients to cross the bridge to recovery, you must first navigate your own bridge—credentialing. Consider it your golden ticket to being recognized as a qualified professional by insurance companies, regulatory bodies, and professional organizations. Without going through the credentialing process, you’re like a powerful train waiting patiently for a green signal — you might have the potential, but you’re not moving forward!

With a mountain of paperwork to deal with, credentialing documentation can be overwhelming and time-consuming for new physical therapy practice or clinic owners. From the initial application to ongoing monitoring, each stage involves extensive evaluations and verifications around education, training, and professional history. 

It would be so much better to offload the burden and use a tool that can automate the entire process. Not only will this save time and effort, but dollars, too. Recent studies reveal that healthcare organizations can save up to $9000 per provider per day in lost or delayed revenue streams by optimizing credentialing. 

Keen to learn more? Let's dive straight into the basics of physical therapy credentialing.

The Basics of Physical Therapy Credentialing

Credentialing is your first official handshake with insurance companies as a physical therapy provider. It’s the process where you show you’ve got the right credentials: your physical therapy degree, state license, and so on. 

It is your first formal step into networking with the payers. Now, don’t confuse physical therapy credentialing with contracting. While credentialing ensures you’re the real deal — a licensed, qualified professional, contracting is where you negotiate the terms and rates with insurance companies. One gets you in the door, the other decides how much you’ll get paid once you’re inside. 

Getting your PT management credentialing in order is important because:

• Without credentialing, insurance companies may not recognize you as a provider, which means you won’t get reimbursed for your services.
• Most patients prefer to use their insurance, and being credentialed allows you to accept a wider range of insurance plans.

Fair warning: Credentialing is not an overnight deal. It can take a few months, so the sooner you start, the better!

To get started, you will need the following PT credential documents.

• Physical therapy degree
• State license
• Any extra qualifications or specialties 
• Professional liability insurance
• Resume/CV
• National Provider Identifier  

Now that you know the whys and whats of credentialing, let's learn how to get there by yourself. 

Six Pillars of Credentialing Mastery for PT Owners

Here’s a roadmap with six pillars to guide you to credentialing success.

1. Proactive Approach: Begin Early and Stay Organized

Credentialing is like preparing for a marathon, not a sprint. Starting early gives you enough time to gather all your documents, double-check for any hiccups, and avoid last-minute panic. Whether you’re a fan of old-school filing systems or prefer using modern credentialing software, staying organized is key. Keep track of every detail to ensure nothing slips through the cracks.

2. The Devil is in the Details: Understand Specific Requirements

Not all insurance companies play by the same rules. Each has its own set of requirements, and knowing these inside and out is crucial. Take the time to familiarize yourself with the specific guidelines, prerequisites, and timelines of each insurer you plan to work with. Staying updated with any changes in their criteria will help you avoid surprises down the road.

3. The Bedrock of Trust: Ensure Accurate Documentation

Your credentialing success rests on one solid foundation—accurate and truthful documentation. This means:

• Keeping your CV up-to-date, with a clear, chronological account of your professional journey, leaving no gaps unexplained.
• Safeguarding copies of essential documents like your degrees, state licenses, malpractice insurance, and any other relevant certifications.
• Regularly validating these documents to ensure they remain current and valid.

4. The Cycle of Renewal: Regularly Review and Update

The healthcare landscape is constantly evolving, and so are the rules and requirements for credentialing. It’s wise to adopt a proactive approach to reviewing and updating your credentials regularly. Aim to review your credentials at least annually or every 2 years as stated by the National Institute of Health (NIH), updating any expired documents such as licenses or certifications. This practice will keep you in compliance and save you from last-minute scrambles.

5. The Human Touch: Foster Relationships with Insurance Providers

Credentialing isn’t just about paperwork; it’s also about people. Building strong relationships with your insurance providers can make the process smoother. Understand their challenges and expectations, and keep the lines of communication open. A good relationship often leads to quicker resolutions and easier collaboration when issues arise.

6. The Expert's Lens: Consider a Credentialing Service

If the credentialing process feels like a maze, don’t hesitate to bring in the experts. Credentialing services specialize in navigating this complex terrain, ensuring you meet all requirements and deadlines without a hitch. They can be a valuable resource, especially for new PT owners juggling multiple responsibilities.

Best Practices for Efficient Credentialing

To make sure your credentialing process runs smoothly, here are some advice that can make a big difference:

Conduct Peer Reviews

Imagine you’re assembling a dream team for your practice. Before any player joins, you want them to be at the top of their game. Peer reviews work the same way—by having a system where experienced team members review each other's qualifications, you ensure everyone meets the highest standards. For instance, if you’re bringing in a new physical therapist, have them undergo a peer review to confirm that they align with your practice’s quality of care.

Standardize Credentialing Protocols

Think of it as creating a recipe for success. Just like a chef follows a consistent recipe so that the dish turns out perfect each time, standardized protocols for credentialing will leave no room for errors. This means having clear, step-by-step instructions for each part of the process, so nothing is left to chance.

For instance, if you’re credentialing a new therapist, you’ll know exactly what documents are needed, what forms to fill out, and who needs to sign off — no guesswork involved! 

Secure a DEA Number

If you plan to prescribe medications, think of your DEA number as your license to drive on that road. Without it, you’re stuck at the starting line. Apply for your DEA number well in advance, especially if you work in multiple states. This way, you’re ready to hit the ground running when your practice opens.

Establish a Credential Tracking System

Picture this: You’re juggling a dozen balls in the air, and you can’t afford to drop any. Credential tracking is like having an extra pair of hands to help. Set up a system that alerts you when any credential is nearing its expiration date. You could use credential management software that sends reminders a few months before a license expires, so you have plenty of time to renew it and stay compliant.

Remember, credentialing is an ongoing process that requires attention to detail and an understanding of the healthcare system's intricacies. By staying informed and proactive, you can navigate the credentialing landscape successfully and set your PT practice up for success. 

Stay tuned for more insights on managing a thriving physical therapy practice! Visit the SPRY blog to read more articles on using technology to handle the all-important administrative functions in physical therapy clinics.

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