ABOUT

The client provides advanced gastroenterology services in New Jersey.

CHALLENGES

We discovered that a client we started working with had registered the practice under two names (one that said MD PC and the other as just MD) but was not aware of the same. During the revalidation process from Medicare, the insurer decided to terminate the contract with the practice.

WHAT WE DID

We worked with Medicare and identified the name that was associated with the doctor’s IRS account. After receiving appropriate information from the IRS, we recredentialed the physician with Medicare as though he was just getting started. While this definitely disrupted payments until the credentialing was complete, it ensured long-term compliance with Medicare without any loss of income.

CONCLUSION

Medicare and other insurers have a variety of ways to ensure compliance from the name of the practice to qualifications of the provider. Often a compliance and credentialing expert is required to ensure that a provider is accurately credentialed. As this case highlights, inaccuracy can result in cash flow disruption sometime in the future too. Do not compromise on your compliance status.