Difference Between Provider Credentialing and Provider Enrollment

Hiring incompetent healthcare providers or allowing them to remain with your facility can lead to increased liabilities in malpractice suits. In order to ensure that your facility does not suffer from this, it is important that credentialing and enrollment of your providers is managed properly and kept up to date. Failure to do so can and will have a negative impact on your revenue cycle. Add to this, the regulatory requirements under which your facility can be at risk of compliance violations.

To ensure that your provider credentialing and enrollment processes are managed properly, it is important to understand the difference between the two.

Provider Credentialing

Credentialing refers to the process of verifying the proven skills, training and education of healthcare providers. Verification of the providers credentials are done by contacting the “Primary Source”, which has provided the license, training and education. The credentialing process is used by healthcare facilities as part of their hiring process and by insurance companies to allow the provider to participate in their network. Credentialing is also the validation of a provider in a private health plan and the approval to join the network.

Provider Enrollment

Enrollment refers to the process of requesting participation in a health insurance network as a provider. The process involves requesting participation, completing the credentialing process, submitting supporting documents and signing the contract. Enrollment is also the validation of a provider in a public health plan and the approval to bill the agency for services rendered.

Importance of Provider Credentialing

Provider credentialing dates back to 1000 BC, and has been an important if not critical part of healthcare services. The process of credentialing has undergone many changes over the centuries; however, the content of credentialing has remained the same – a verification of the education, training, experience, expertise and willingness to provide medical services by the provider. It was around 1990, that national organizations started which were dedicated to the credentialing of medical providers. Around the same time, the National Committee for Quality Assurance (NCQA) set guidelines on the process and method of credentialing medical providers.

These guidelines ensure that healthcare providers have undergone stringent scrutiny with regards to their ability and competence, thus making sure that the patients receive the highest level of healthcare. For a patient, it is assuring and confidence boosting to know that your healthcare provider’s credentials are certified as through the credentialing process, thus ensuring that you are in good and competent hands. For the provider, it states that their colleagues are held to the same standards as them. For the healthcare facility, it shows that they value quality care and place the patient’s well being as a primary goal.

It is very important to remember that in today’s world of health insurance and revenue cycles, improper credentialing can lead to delayed or denied reimbursement for services provided. Worse, it could lead to serious consequences for all concerned in terms of statutory compliance violations, which can result in monetary damages and criminal charges.

Provider credentialing and enrollment has been overlooked as an important component of healthcare management practices for years. However, their impact on compliance issues and financial aspects to a practice has ensured that these are now key components to any thriving practice.

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Why Do We Take A TMT Test?

A cardiac stress test, is also known as a cardiac diagnostic test. This is primarily a cardiological test that is designed to measure the heart’s ability to respond to every kind of external stress in a controlled and clinical environment. The stress response is therefore induced by some exercise or even with some drug stimulation.

The definition of cardiac stress tests:

This is a kind of test that is done in order to compare the coronary circulation, while the patient is at complete rest. Along with this the same patient’s circulation during some maximum physical exertion, showing any kind of abnormal blood flow to the actual myocardium (heart muscle tissue), is measured. The results can, therefore, always be interpreted as a kind of reflection on the overall physical condition of the test patient.

The purpose of the test:

This is a kind of test that can be used to diagnose the coronary artery disease, which is moreover known as the ischemic heart disease, and for the patient prognosis after a myocardial infarction, in other words, heart attack.

The types of cardiac stress tests:

The cardiac stress test is basically done with the heart stimulation, either by exercise on a treadmill, or by pedalling a stationary exercise bicycle Ergometer. Apart from these two this test can be conducted with an intravenous pharmacological stimulation, with the patient connected to an electrocardiogram (ECG).

The main purpose is to increase the level of mechanical stress and hence recognize the activity of the heart. The level of the speed and the difficulty is progressively increased by adjusting the range of exercises. There is, however, not a single test in this genre, but some varied range of tests. They are the following:

ECG – The test is most commonly called a cardiac stress test, done with a device, recognizing your heart activity.
Exercise testing – This is again a kind of test, which is basically said to measure your heart’s activity.
The Treadmill test or TMT Test – The next form of test, which is used for the similar purpose.
The exercise tolerance test – This is done in order to check your heart issues in the most effective manner.

The TMT Test:

The Treadmill test is actually a kind of exercise stress test, which is said to be one of the most common forms of stress tests. The main purpose of this test is to induce, some myocardial ischemia for the diagnostic evaluation of the coronary artery disease. In this TMT Test, the subject or the patient is made to walk on a treadmill, as per the protocol of the same.

As to go with the series of protocols, then one of the common form in the genre is the Bruce protocol. Every stage of this consists of three minutes and hence, it is accurately done. The starting speed is always 1.7 miles per hour (mph) and the gradient is 10%.

Conclusion:

Hence, it can be concluded that this is a special kind of test, which is basically used to measure your heart health. There are some other forms of stress test namely:

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