Healthcare Consulting

Credentialing Services

Without successful credentialing, provider reimbursement will be delayed or, even, denied.

One of the most critical steps to take before seeing patients is to become credentialed with major payors.  While not every payor requires a provider to be credentialed before they begin to see patients, many of the major payors do. This includes Medicare, Medicaid, BCBS, United Healthcare, Tricare and more.

Credentialing can be a tedious and time consuming process that takes weeks of follow-up and constant attention to stay on track. Most credentialing processes take anywhere from 60 – 120 days, depending on the payor, so be sure to keep this in mind when hiring on a new provider or starting up a new office or clinic.

Tips for Credentialing

Provider credentialing is more than just another form to fill out or a minor nuisance. It’s a complex, ongoing process and a critically important one, at that. Given its many steps, critical deadlines and uncertainties, provider credentialing is business critical for your practice.

Also keep in mind that contracting with commercial payors is often required before credentialing can begin….and it is a very time-consuming process. Most commercial plans require contracting and credentialing, which slows down their timeline for approval even more.

Legacy can handle credentialing for a new physician or mid-level provider or the ongoing re-credentialing required by most payors. We can also handle the facility contracting, CAQH setup, ongoing quarterly CAQH maintenance as well as hospital privileges, if needed. CAQH is an online database that facilitates faster processing for re-credentialing and holds physician supporting documentation, but must be kept current in order to be useful.

Credentialing is an integral part of the revenue cycle and if providers are not enrolled correctly, they will not be paid correctly, if at all. Everything that we do, is focused on helping our clients take control over the credentialing life cycle and to generate more cash, faster. Helping clients grow operationally and financially is our passion. Contact us to discuss the return on investment (ROI) for your group or individual clinician.

Let our Consultants take on this process for you to ensure it is complete by the time you are ready to see patients – preventing any delays in billing.

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Interim Practice Management

The Legacy team can help to relieve the administrative burden of running any practice. Whether a new-start up, or bringing on a new provider, there are many steps required to reduce lost revenue once the provider starts to practice.  We can provide interim practice management, if needed. Management changes, loss of key staff members, implementing new software or systems, consolidations or acquisitions, can all have an impact on your quality of care and ultimately on your bottom line. It’s not just about filling a vacant position for a short period of time, it’s about seamless support from start to finish. 99% of the work we do is remote and works beautifully because of today’s technology. We view each assignment as an opportunity to help your organization become successful. We begin each engagement by understanding your needs so that organizational improvement will occur.


Tired of your current EMR?

Our Project Managers can help with the implementation and conversion of a new Electronic Medical Record.

Are you certain you are charging enough for your services?

Our Analysts can review your Charge Master, perform a reimbursement analysis and provide recommendations for changes.

Is your billing being done timely, correctly and in such a way as to ensure proper coding and reimbursement?

Auditors can review charts to determine just that.

Experiencing management turnover that is impacting your cash flow?

Our Senior Consultants will assess and operationalize as interim management to assist your organization.

We provide daily operational guidance, along with weekly meetings and monthly AR reviews to keep staff on track with administrative functions, including all aspects of the front office and back office. We can assist for a short-term or long-term practice management staffing need.

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Billing Integrity Audits

Have you wondered if your billing is going out correctly?  Or if coding is being handled properly with proper CPT codes, modifiers, etc.?  Are all of the charges being captured timely?

One of the many services Legacy Consulting provides is a Billing Integrity Audit. There are several layers to this kind of audit and we can provide all or just some of the pieces, depending on each client’s needs. These audits can prove useful to assure compliance and ensure timely and accurate reimbursement.

• Every practice needs and confirmation that they are billing and coding correctly and compliantly– both for clinical reasons and reimbursement reasons. Our team can take a selection of charts per payor and per provider and do a thorough audit of each chart to confirm the proper documentation, correct coding, and appropriate billing levels were sent out on each claim.
• Along with the documentation, we will review billing and coding to ensure your practice received the maximum reimbursement allowed, based on the clinical documentation. We will identify any gaps with modifiers, CPT codes or diagnosis codes, particularly with ICD-10, and ensure the appropriate billing levels were sent out on each claim.
• We then provide an assessment of where we see deficiencies or areas of concern. We provide a suggested action plan and are available to help carry out any of the steps along the way with our Medical Billing Services. We also look at potential underpayments, overpayments, fee schedule discrepancies, EOB Reviews and provide ICD-10 training if needed as well.

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Payer Contract Negotiation

Is your reimbursement below what it should be?

In today’s healthcare payment landscape, every dollar counts—increasing regulations and decreasing reimbursements seem to be the name of the game. Today’s contract environment is tougher than ever. Commercial payers are adjusting rates. The government is exerting downward pressure on fees. It’s easy to let payer contracts fall off your radar. And it may be tempting to maintain the status. With the potential for declining reimbursements practices that do not monitor contracts could be foregoing thousands of dollars. Negotiating contracts and fee schedules regularly is essential to optimizing reimbursement and, ultimately, yields a significant return on investment to your organization.

That’s why now, more than ever, it’s crucial that you get the most out of your payer contracts—and to do that, you’ve got to negotiate.

With practice expenses increasing, boosting reimbursement from private payers is one way to stay in business. But successful negotiation is easier said than done.

Legacy can handle the contract review, reimbursement analysis, and renegotiation on your behalf. In order to be effective, this needs to be annual process.

  • We analyze your current reimbursement compared to fee schedules and start contract review and negotiations.
  • Compare the overall weighted averages of all of your healthcare plans.
  • Most health plan contracts are evergreen and will automatically renew unless one party proposes a modification.
  • In preparation for contract negotiation, we set a range that includes an optimum, minimum, and target goal.

Some physicians feel forced to accept truly poor contract terms, because rejecting the contract would result in the disruption of ongoing care for some patients, decrease in the number of new patients, interference in established referral patterns, and loss of income. We take on that burden and most payers want to work with us to keep physicians in-network for their patients.
Practices that have more favorable payer contracts will be in a better position to compete and thrive – even in “this age of declining reimbursements.”

Let us conduct managed care contract and practice reviews, maximizing revenue opportunities.

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Compliance Planning

Why do you need a Compliance Plan?  How do you monitor compliance for billing, coding and documentation purposes?

A compliance plan ensures reasonable effort is being made to identify compliance issues and to eliminate or mitigate those issues. Establishing an effective compliance plan has become a necessity to detect and prevent improper conduct and promote adherence with guidelines.  The importance and complexity of compliance programs has increased in recent years. The time to start with updating or developing your compliance plan is now.

Developing a compliance plan on your own can be both time-consuming and confusing as regulations changes and clarifications are issued. Legacy can help you implement the right plan to reduce your non-compliant exposure and liability, avoid denials, and realize the optimal level of income for your practice.


The Legacy team can develop a plan specifically tailored to your organization.

Let us help you develop a Compliance Roadmap for your practice!

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Reimbursement Analysis

Because the charge master is at the heart of the billing and coding process, it must be analyzed and updated annually. However, charge masters are often overlooked and, once a practice has been in business for a while, it is easy to get complacent.

Are you charging enough for your services? Has anyone reviewed fee schedules to be sure you are billing at least that amount?  Are fee schedules loaded into your practice management system for performing reimbursement analysis?

If you are charging below what a payor is willing to pay, they will only reimburse the lesser charge amount. Our Analysts can do a comprehensive Charge Master Review. This includes taking a utilization report of the top 20-50 codes for the practice, and mapping those codes to all available fee schedules for the practice. We can then assess whether the Charge Master is an accurate representation of what payors are reimbursing you, or if there are changes that need to be made. We can even assist in updating your system charges for you to ensure everything is up-to-date based on your current fee schedules. We recommend that fee schedules be loaded into the practice management system for tracking what payors are paying you, compared to your charge master. We can even assist with loading the fee schedules into your system. You could be losing cash by just not knowing if you are being paid your contracted rates.

We also can recommend if it is time for your fee schedules to be re-negotiated with our Contract Negotiation services. Having someone review your contracts on an annual basis is a critical task that most offices ignore.

Let us help you review your Charge Master and Fee Schedules!

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Practice Management or EHR System Selection/Implementation

Are you Frustrated with Inefficiencies in your PM or EHR System?

The opportunities for automation in the physician practice have rapidly increased in recent years. From eligibility verification to claims submission and patient billing, many formerly manual, time-intensive administrative tasks can be streamlined and simplified with practice automation. While the benefits of moving from manual to automated processes for these tasks are clear, choosing and purchasing an appropriate Practice Management System can be an overwhelming task.


If you are considering the move to an Electronic Health Record (EHR) for the first time, or you are not satisfied with the system your office is currently using, our consultants can help you determine the best possible options for your practice. Our experience and expertise with dozens of systems gives us the knowledge to find the best fit for you. We can assist with scheduling demos, creating Requests for Proposals (RFPs), even negotiating the pricing for your contract to make sure you get the best long-term rates for your new system. We also assist with selecting and implementing electronic clearinghouse vendor.

Our Project Managers can also assist in the implementation phase of your EHR and Practice Management systems to ensure everything stays on track and meets your established deadline.

We are the System Experts…Call Us!

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