1. Preventing "Key Man Risk":
- Diversify Your Supervisors: Having more than one credentialed supervisor (with an LPCC-S or similar qualifications) reduces dependence on a single person. If one supervisor leaves or becomes unavailable, you have a backup.
- Cross-Train Staff: Make sure multiple staff members understand the credentialing and billing processes, so the departure of a single key person doesn't derail operations.
- Automate the Credentialing Process: Use credentialing software to keep track of your supervisors' credentialing statuses and deadlines, which can help you be proactive about renewal and finding replacements if needed.
- Contractual Protections: Implement clauses in contracts with key supervisors, like non-competes and extended notice periods, to protect against sudden departures.
2. Finding a Good Medical Credentialer:
- Look for Experience in Your Specialty: A credentialer with a deep understanding of behavioral health and Medicaid requirements in Kentucky is essential. Look for people who have worked with similar practices or can show familiarity with both commercial insurance and Medicaid credentialing.
- Use Professional Networks: Ask for recommendations from colleagues in the behavioral health or medical fields. LinkedIn, industry forums, or associations like the Kentucky Counseling Association may also have leads.
- Credentialing Firms: There are specialized credentialing companies that handle everything from initial credentialing to re-credentialing. Vet them by asking for client references, looking at their process efficiency, and inquiring about their track record in getting providers enrolled with insurances.
- Track Record and Reviews: Ensure they have a proven history of meeting deadlines. Request case studies or references where they handled complex situations (e.g., multiple insurances, re-credentialing issues).
3. Evaluating Which Insurances to be In-Network With:
- Prioritize Medicaid: Since Medicaid is a significant payer in behavioral health, you should absolutely be in-network with them. In Kentucky, many of your clients will likely be Medicaid recipients, so it's essential for volume and continuity.
- Local Market Research: Determine which commercial insurance companies are dominant in your region. This can vary by location, so research the most common insurance plans in Northern Kentucky.
- Focus on Value-Based Plans: Some commercial insurers may offer better reimbursement rates or more reliable payments. Try to be in-network with companies that reimburse at higher rates, even if their patient volume might be lower.
- Diversify Payers: Having a mix of Medicaid and commercial insurers helps balance the lower reimbursement rates from Medicaid with the higher rates from some commercial plans.
- Longevity Consideration: Some commercial insurers have a history of either cutting behavioral health services or reducing reimbursements, so try to monitor the stability and growth of the insurers you work with.
Preventing billing delays, hiring the right credentialers, and selecting the appropriate insurance networks can help you avoid the major financial risks that come with credentialing issues.
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