Billing and credentialing for new practices
You cannot bill a payer you aren't enrolled with, and enrollment takes months. Getting this wrong delays revenue past opening day.
What actually goes wrong
The most expensive mistake a new practice makes is starting credentialing too late. Commercial payer enrolment routinely takes 60 to 180 days. If applications go in the month before opening, the practice opens its doors to patients it cannot bill for, and the revenue gap lands exactly when cash reserves are thinnest.
The second mistake is signing the first fee schedule offered. Payer contracts are negotiable in some markets and not in others, but they are always reviewable — and a rate that is ten percent below market compounds across every claim for as long as the contract runs. Reviewing it takes a few days. Living with it takes years.
The third is setting up the billing workflow after the practice is already busy. Charge capture habits, documentation templates, front-desk collection scripts and eligibility routines are far easier to establish before there is a waiting room to manage.
We start with credentialing, work backwards from your intended opening date, review every fee schedule before you sign it, and have the billing cycle running from your first patient rather than your first denial.
How we work with new and startup practices
- Credentialing-first onboarding, planned backwards from your opening date
- CAQH, NPI, PECOS and Medicaid enrolment handled together
- Fee schedules reviewed before you sign anything
- Charge capture and documentation templates set up before day one
- Front-desk eligibility and collection routines established from the start
- Effective dates confirmed in writing so you know when you can bill
The timeline, worked backwards
Credentialing is the constraint, so the plan starts at your intended opening date and works backwards from it.
Six months out. Collect documents once, centrally: licence, DEA, board certification, malpractice face sheet with current dates, diploma and residency certificates, and a CV in month-and-year format with no unexplained gaps. Build and attest the CAQH profile. Decide which payers actually matter for your patient population rather than applying to everything.
Five months out. Commercial and Medicaid applications go in. Medicaid frequently means the state programme first and then each managed care plan separately, which is the step most new practices discover late.
Four months out. Medicare enrolment via PECOS, and the follow-up cadence starts. This is the single biggest determinant of how long the whole thing takes.
Two months out. Contracts and fee schedules arrive as approvals land. Each one is reviewed before signature. A rate below market compounds across every claim for the life of the agreement, and this is the only moment it is cheap to change.
One month out. Effective dates confirmed in writing, billing system configured against them, and charge capture and documentation templates set up before there is a waiting room to manage.
Getting the workflow right before you are busy
Habits formed in the first month persist. Charge capture that relies on someone remembering, a front desk with no eligibility routine, and documentation templates that do not prompt for what payers require are all far easier to fix now than in month six.
We set up the eligibility routine, the point-of-service collection script and the charge reconciliation against the schedule before the first patient, so the practice starts with a process rather than acquiring one after the first bad month.
What we will tell you honestly
Not every new practice should outsource billing on day one, and we will say so if your volume and payer mix suggest otherwise. What almost every new practice should outsource is credentialing, because the cost of getting it late is measured in months of revenue rather than in fees.
How onboarding works
The same five steps whatever the size of the practice.
- 1 Free A/R analysis We review your last 90 days of claims data and show you where money is being lost. No cost, no obligation.
- 2 Proposal and scope A written scope and fee, based on your collections volume and specialty.
- 3 Systems access We connect to your EHR/PM system in read-and-write mode with a signed BAA in place.
- 4 Parallel run We run alongside your current process for the first two weeks so nothing drops.
- 5 Full handover We take the cycle end-to-end, with weekly reporting from day one.
Questions from new and startup practices
When should we start credentialing?
Work backwards from your opening date. Commercial enrolment routinely takes 60–180 days, so applications should be in well before you see patients.
Will you review our payer contracts?
Yes, before you sign. Fee schedules are reviewed against market and flagged where they are below it.
Can you set up our billing workflow?
Yes — charge capture, documentation templates, eligibility routines and front-desk collection scripts, before day one.
Related
Where this connects to the rest of the cycle.
Provider Credentialing & Payer Enrollment
Payer enrollment, CAQH management, re-attestation, and contract negotiation.
See provider credentialingMedical Billing
Charge entry, claim scrubbing, submission, and payment posting across all major payers.
See medical billingEligibility & Benefits Verification
Coverage and benefits confirmed before the visit, not after the denial.
See eligibility verificationRevenue Cycle Management
The complete cycle, end to end, with weekly reporting and a named account lead.
See revenue cycle management