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Credentialing and Merging Medical Clinics

If you have acquired an organization or want to merge two of your clinics/practices, it's important that you have an understanding of how the providers are credentialed as you choose the best course forward.


While some owners keep their practice separate, there are several reasons why they might want to merge. Merging medical practice and credentialing providers can be a complex process with both potential benefits and challenges. 


Benefits:

  • Efficiency and cost savings: Streamlining credentialing processes for combined clinics can eliminate redundancies, saving time and resources. Shared staff and centralized databases can further reduce administrative costs.

  • Improved access to care: Merging can enhance service offerings and patient access to specialists or broader care options within one platform.

  • Enhanced negotiating power: A larger organization may have greater leverage with payers and suppliers, potentially leading to better contracts and improved financial stability.

  • Knowledge sharing and collaboration: Combining expertise and resources from different clinics can lead to improved clinical practices and innovation.

Challenges:

  • Regulatory compliance: Navigating different state and federal regulations for credentialing across merged clinics can be complex. Ensure proper adherence to all relevant standards.

  • Cultural integration: Merging clinic cultures can be challenging. Clear communication, transparency, and sensitivity to existing practices are crucial to build trust and collaboration.

  • Provider onboarding and retention: Attracting and retaining qualified providers is essential for success. Address any concerns they may have regarding changes in roles, workload, or compensation.

  • Technology integration: Merging different IT, and billing systems can be disruptive and costly. Consider a phased approach and invest in robust technological solutions to ensure smooth data migration and interoperability.

  • Financial considerations: Carefully evaluate the financial implications of the merger, including potential revenue synergies, cost savings, and integration expenses.


Even though you have a new practice, each practice's credentialing process must still be followed until certain structural changes take effect. This means that practitioners from practice "A" cannot automatically begin practicing at practice "B" without going through the credentialing application process.


The assumption that even though they practice at a practice that is under the same health system as your practice, the providers cannot immediately start working at clinic "B". Each practice has a separate is credentialed under their respective Tax ID and NPI number. If you've read the article Credentialing vs Contracting you'll know that this is because each enrollment is tied to one Tax ID or SSN. It doesn't "transfer over". This needs to be updated so that all of the individual providers operate under the same Tax ID and NPI.


This is like two ships in the sea. Ship A has taken over Ship B and wants to take on the crew. Each crewmate has to be vetted and put on Ship A's roster before Ship A can continue sailing.




Another scenario is that a third Tax ID and NPI is created, and practice A and B providers are credentialed under that new combo. This is done so that a new name can be made, a new taxonomy is chosen to reflect the services offered, and so that the billing can continue under practice A and B's info while the credentialing takes place.


This is like two ships in the sea and the owner decides they need a bigger ship to hold all of the crew. So, a third ship is built while the first two sail around as normal. Once the third ship is built, then the crew from the first two ships are vetted and put on the third ship's roster so it can sail.





Before you choose how to proceed you should ask yourself these questions.

  1. Does the name and/or taxonomy need to change?

  2. Can you afford to pause billing should that be needed as you merge clinics?

  3. What is your long term plan? Multiple clinics or one?

  4. What services do you want to offer? Do you want a multi-specialty practice or a single-specialty?

Once you've decided how to proceed, you need to look at the finer details to ensure a smooth process. These are a few of the crucial details to consider.


  1. How the practice will bill until the credentialing is finished.

  2. Are the providers going to stay through the merge?

  3. Are there any insurances that you need to add or drop?

  4. Do all of the providers meet the provider enrollment requirements?



Merging medical practice and credentialing providers can be a strategic move to improve efficiency, access to care, and financial stability. However, it requires careful planning, meticulous execution, and a strong commitment to patient care and provider well-being.


If you are in the middle of or about to go through this process and need help understanding all the details, schedule a free consultation today! We can help you decide which course best fits your practice and goals.





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