A complete guide to medical credentialing services
Credentialing is the method of confirming a carrier’s credentials to make sure that they are eligible to give treatment to patients. The majority of health insurance providers, including CMS/Medicare, Medicaid, and Commercial programs, as well as hospitals and surgery centers, require this procedure. It is a procedure of getting in-network with different insurance providers.
Medical credentialing services are a common term amongst medical practitioners these times, particularly among therapists, physiotherapists, and even massage therapists who could only operate “cash only” practice some few years back. Currently, however, such providers are discovering that many patients and clients expect them to consider their insurance as payment. if they don’t, they seek another practitioner that does accept the insurance as their payment.
As a result, when you’re not credentialed with major insurance firms, you are effectively turning away clients and the benefit they will offer you.
Getting credentialed (either on insurance boards) entails collecting and sorting out a series of insurance company applications (which may require up to 10 hours per panel), sending the applications to insurance firms, ensuring that each has accepted the application, and then doing a lot of follow up to monitor the progress from each application.
Although there appear to be just a few steps that seem easy enough to complete, health professionals often characterize the application process as “terrifying,” since it sometimes goes smoothly.
There are a few things to keep in mind to make the process go more smoothly:
Form a list:
Research thoroughly all the insurance providers, form a list, and find the company you want to be credentialed with. Different companies comprise different requirements and procedures that you have to go through.
Council for Affordable Quality Healthcare:
The Council for Affordable Quality Healthcare, or CAQH, is most often required following an insurance company’s application to accomplish medical credentialing services (i.e., to get on insurance panels). CAQH is used by major insurance providers such as BCBS and Aetna as part of their application process.
There are some aspects you should be aware of about your CAQH application.
- You need to be invited. You can’t just go to CAQH and fill out a form; you must be sponsored by an insurance provider. Firstly, you have to apply to the company, then wait for two weeks to assure that your application has been received and your CAQH number has been generated. After receiving the number your application will be sent to the insurance company who will complete it.
- Your resume should be perfect: make sure your resume is up to date, with perfect dates of employment and education in its format. If the data is not properly mentioned then there are the chances of the rejection of your application. They won’t further send it to the insurance companies.
- Filling out your CAQH on paper is never a good idea. Medical practitioners can complete an application online or on paper, according to CAQH. Selecting the paper choice is not a good idea. For starters, the application is 50 pages in length and can only be printed in color. However, once you send a paper application to CAQH, they will have to employ a data entry individual to process all of your details. If you call to inquire about your paper application, they advise you to submit your CAQH application online.
- Re–attest: Ensure that the provider performs a “re-attest” every 4 months. Re-attesting is a fast and easy way to ensure that anything in the service provider profile is still correct. When providers don’t re-attest, insurance firms do not have access to their profile records, which can cause credentialing delays.
Spare 10 hours for each insurance company:
If you expect to fill your application in just a few minutes, you can do something wrong out of frustration. To avoid any blunder, expect at least 10 hours for each company you want to be credentialed with. During this time, you’ll be gathering forms, filling them out, arranging required paperwork, and calling insurance companies to follow up. Although some applications are available in digital format, a large percentage must be printed and done manually.
You should call the insurance company for follow up in a week or two:
Many insurance companies lose the application or get stuck in the limbo where they are mostly expired. The medical credentialing service process goes nowhere if the application is not reviewed properly for weeks and automatically gets rejected. In that case, you will have to start your application from the first step again.
Hence, you should call the company after every one or two weeks to check up on the status of your credentialing applications and to avoid any mishap.
Seek medical credentialing help:
Using a reliable provider to assist through medical credentialing makes more sense for several medical practitioners. Using a credentialing program relieves not just the process’s stress and headache, but also saves time. Singing a program will also save money, and reliable service is more likely to get you credentialed quickly, allowing you to start treating insurance clients earlier rather than later.
Information that is required for Medical credentialing service
The required information and certificates may vary amongst the providers but usually the process is similar. During the procedure, the health care provider submits basic information regarding social security, degrees, graduation dates etc. However, to be precise, here is the list for some of the information that is required for medical credentialing services.
- The license of practice and verification.
- History of your work.
- Insurance information.
From beginning to end, the credentialing process generally takes 90-120 days. As a result, if you’re planning to open a private practice, don’t put off going through the process until the week before you start your business! ‘
There is no way, that makes getting on insurance panels is a simple task, however with the right training, resources, and perseverance, you could get credentialed. Make it a New Year’s resolution to get credentialed, particularly with the upcoming changes in health reform in 2013 and 2014.
What Does a Breast Reduction Procedure Entail?
The physical and mental health of a woman might be negatively impacted by having noticeably big breasts. Some people get persistent headaches and neck/shoulder discomfort as a result of them. Some women with enormous breasts have back discomfort, while others avoid sports and other forms of physical activity because they are unpleasant. Some women may have mental health issues including sadness, anxiety, or poor self-esteem as a result of this problem.
Reduction mammoplasty, surgical treatment to lessen the size of one’s breasts. As a result of the surgery, discomfort and other problems related to large breasts are reduced. Over 101 thousand breast reduction surgeries were carried out in the USA in 2018. Generally speaking, women have positive outcomes, including enhanced ease, a more positive body image, and enhanced quality of life.
When should you consider it?
The surgical treatment to decrease breast size and weight is known by many different names. Surgeons perform reduction surgery to reduce the size of the breasts by removing a portion of the breast tissue, some of the fat, and some of the skin. In addition to this, the surgeon will contour the breast and move the nipple and areola (the black region surrounding the nipple), which the medical community refers to as the nipple-areola complex (NAC), in order to better place it on the breast that has been reduced in size.
Under what circumstances may you need breast reconstruction?
Females with symptomatic breasts (macromastia or gigantomastia) are good candidates for breast reduction surgery. Evidence of persistent neck, lumbar, and/or shoulder discomfort, bra notching, skin rashes beneath the breasts, or any of a variety of additional issues attributable to the size or weight of the breasts is required for symptomatology.
For the most part, women with too big breasts have reduction surgery (https://www.healthline.com/health/womens-health/breast-r (healthline.com)) to alleviate the following symptoms:
- Problems with your neck, shoulders, breasts, and/or back
- Continual head pain
- Incorrect stance
- Hand and/or arm numbness and/or tingling due to nerve issues.
- Skin infections and/or rashes in the bra area
- Disruption of regular routines and physical activity
- Low self-esteem and/or anxiety
- Breathing problems while laying down
- Notches and divots in the flesh created by bra straps.
- Problems obtaining well-fitting garments.
Several insurance companies may pay for breast reduction surgery if the patient can prove she suffers from the aforementioned conditions. The patient’s insurance company may mandate that they attempt non-invasive treatments like physical therapy, diet, and exercise before they cover any invasive procedures. Click here for more on physical therapy.
If a woman does not have a medical reason to undergo breast reduction surgery or if her insurance company refuses to pay for it, she still has the option of having the procedure done at her own expense.
What should a woman expect before undergoing breast reduction?
It is crucial to get with a surgeon and talk about your expectations and concerns about the treatment before going through breast reduction. Patients should discuss their ideal cup size with their surgeon before undergoing breast augmentation. Women who want children in the future and are considering breast reduction surgery should talk to their surgeon about the potential risks and benefits.
If a woman has a history of breast cancer in her family, a lump in her breast, or other risk factors, she may need to have a mammography to check for cancer before undergoing reduction surgery. Blood thinners may need to be stopped before surgery. Women who smoke should give up the habit no less than 8 weeks before their breast reduction surgery, and ideally much longer.
After you get breast reduction surgery, what can you expect?
A woman undergoing breast reduction surgery will be put to sleep under general anesthetic (https://www.mayoclinic.org/tests-procedures/) so that she does not wake up feeling any discomfort.
Breast reduction may be accomplished via a number of different surgical methods. The surgeon chooses the method that’s best for the patient. The standard method involves an incision from the top of the areola down the front of the breast to the underside. The surgeon will next remove any extra breast skin, fat, or tissue and may even remove a small portion of the areola if necessary. The next step is to readjust the location of the nipple and areola. The breast is then reshaped and the wounds are closed with stitches.
Excess fat around the breasts may be reduced by liposuction, which can also be utilized to alter their contours. Although there are variations in the procedure, liposuction always involves the insertion of a thin tube into a tiny incision. Subcutaneous fat is removed using a specialized vacuum apparatus. Extreme instances of breast reduction may be accomplished with liposuction alone.
If you are thinking about having your breasts reduced, what are the potential risks?
There is always the chance that anything might go wrong during breast reduction surgery. There is always a chance of infection at the surgical site, clot formation, and excessive bleeding after surgery, all of which are potential risks associated with any surgical treatment.
Besides these general risks, breast-reduction surgery might provide its own unique dangers by way of:
- The size and form of a woman’s breasts may vary.
- The scars can be seen.
- Impaired or absent capacity to breastfeed.
- Under-the-skin fluid collection is medically referred to as a seroma.
- Nipple sensitivity decreases or complete loss; might be transient or permanent.
- a reduction in the amount of blood that flows to the nipple and the areola (the dark region that surrounds the nipple), which may result in the loss of tissue.
- Skin Infection (cellulitis)
- Tissue swelling caused by blood pooling owing to vascular rupture.
- Tingling or aching in the fingers.
How long does it take for the breasts to heal after having them reduced?
After breast reduction surgery, most women may go home the same day. On the other hand, hospitalization for the night is a need for certain patients.
Enhancing Your Health and Quality of Life
Most people find it obvious that health can impact their quality of life. As a result, they underestimate the complexity of the relationship between the two concepts and how much control they have over both. Minor changes can make a surprising difference when it comes to enhancing the quality of life, health, and wellness.
What Is Quality of Life?
Everyone has a general idea of what it is to be healthy. However, quality of life is a much more nebulous concept. Most people think of it as a subjective measure of happiness, but there’s more that goes into maintaining a high quality of life than just finding things to be happy about. Enhancing quality of life requires a commitment to making positive changes like those found in this wellness and lifestyle blog.
How Health Impacts Quality of Life
There are many measures of quality of life. Some apply broadly to entire populations and assume a state of overall good health. Others seek to better understand the impact of specific diseases and chronic health conditions on the overall quality of life. What’s clear from the data in aggregate is that objective health measures have a direct impact on subjective well-being.
This is good news for people who do not suffer from any specific chronic conditions but may have room for improvement in terms of lifestyle-related health metrics. Simple lifestyle changes such as switching to a diet that contains less sugar and fewer processed foods, improving sleep hygiene, or committing to a new exercise routine can have an outsized impact on general health and quality of life, alike.
How Quality of Life Impacts Health
The relationship between quality of life and health doesn’t just go one way. People that report a low quality of life tend to suffer from higher levels of stress, which increases their risk of developing other serious health conditions. Thankfully, just as simple lifestyle changes can have an outsized impact on overall health in many people, there are easy interventions that have been shown to improve people’s quality of life.
Simple Tips for Enhancing Both Health and Well-Being
There’s no way for the average person to eliminate stress from their life entirely. However, people can take steps to change their outlook on life in ways that promote well-being, enhance the quality of life, and thus improve overall health. Try these simple tips to get started.
- Incorporate exercise into daily life instead of viewing it as a chore.
Keep an active mind by learning new skills or information.
Prioritize getting at least seven hours of sleep each night.
Stay organized to create healthier mental habits.
Practice gratitude instead of focusing on unfulfilled desires.
Find effective ways to cope with stress.
Put active effort into maintaining healthy friendships.
People who stay active in body and mind, view challenges as opportunities for growth, and commit themselves to the practice of basic self-care and maintaining healthy relationships almost always report a higher quality of life regardless of objective health measures. Implementing the tips above will help with both health and happiness.
Never Stop Growing
Personal development isn’t a goal to be attained but a daily practice. Remember that no one is perfect and progress isn’t linear. The key to enhancing health and quality of life is to stay committed to attaining this long-term goal even in difficult times. Try to stay on track by seeking inspiration and finding ways to incorporate positive habits into everyday life.
Low Testosterone: Symptoms, Diagnosis & Treatment
Do you find yourself feeling exhausted and weak?
Are you not able to think or focus as sharply as before?
Are you having problems with your sex drive?
If so, then it is possible that you may be suffering from Low Testosterone (Low-T).
Testosterone is an important hormone for men, produced in the testicles. It is responsible for many of the physical and mental characteristics of men. Low testosterone can cause a number of symptoms such as fatigue, depression, decreased libido and difficulty concentrating or focusing.
In this blog post, we will cover everything there is to know about Low Testosterone. We will look at its main causes, symptoms and treatment options.
What Is Testosterone?
Before understanding Low Testosterone it is important to understand testosterone itself. Testosterone is a male sex hormone that helps with various processes in the body including muscle growth, facial hair development and sexual function. It plays a major role in sperm production and erection capability. Without sufficient amounts of testosterone in the body it can lead to various health issues both physically and mentally.
Causes of Low Testosterone
It is normal for testosterone levels to decrease over time as men get older however there are certain factors that can contribute to Low-T such as:
- Hormone imbalances due to medical conditions like diabetes or obesity
- Infections such as HIV or mumps
- Anabolic steroid abuse
- Chronic liver or kidney diseases
- Certain medications including steroids and opiates
These factors can affect the hormones naturally produced by your body which can result in low testosterone levels over time leading to the symptoms mentioned earlier.
The Best Testosterone Boosting Supplement in 2023: TestoPrime Review
Symptoms of Low Testosterone
The most common symptoms associated with low testosterone are reduced energy levels, fatigue and decreased libido. Some men may also experience mood changes such as depression or irritability.
Other physical changes associated with low T include reduced muscle mass, increased body fat and an overall decrease in strength and vitality. Some less common symptoms include night sweats, breast enlargement (gynecomastia) and hot flashes.
In some cases, male infertility may be linked to a lack of testosterone production.
There are several warning signs that may indicate low levels of testosterone:
- Fatigue – feeling tired all the time even after sleeping 8 hours per night
- Depression – persistent feelings of sadness or hopelessness Despair Loss of energy / motivation Apathy Inability to regulate moods Reduced libido (sex drive) Difficulty gaining muscle mass Decreased beard growth Anxiety/irritability Bone loss Weight gain Hot flashes Sleep disturbances Erectile dysfunction Hair thinning/loss
If you have been experiencing any of these symptoms then it may be time to get tested for Low-T. While some men experience only one symptom others experience multiple although unfortunately most men often confuse these signs with simply getting older and don’t seek medical help until their condition has become more severe.
How Is Low Testosterone Diagnosed?
The first step for diagnosing this condition is a simple blood test that measures your total amount of circulating hormones (known as Total T). This will determine if your level falls below what’s considered “normal” on average for an adult man between 19-50 years old (which usually means below 300 ng/dL).
Diagnosis of low testosterone involves testing for the hormone through either blood tests or saliva samples to determine whether the patient’s levels fall within the normal range. Blood tests will measure the total amount of testosterone produced by the body whereas saliva tests measure the bio-available amount that can be used by cells throughout the body.
It is important to note that certain medical conditions can affect test results so it is best to consult with a healthcare professional before testing for low T.
Your doctor may also order additional tests such as free T4 & TSH (thyroid-stimulating hormone) depending on other factors like thyroid function or previous examinations results. They will use this information along with physical examinations and patient history to diagnose Low Testosterone more accurately.
Read More: The Best Supplements for Building Muscle and Cutting Fat
Treatment Options for Low T Levels
Treatment options for low testosterone vary depending on severity and underlying cause but generally involve either medications or lifestyle modifications such as dieting and exercise in order to boost natural production of the hormone.
Medication therapy involves taking supplements such as HCG (human chorionic gonadotropin) or testosterone replacement therapy (TRT). Lifestyle modifications include dietary changes (increasing protein intake) and increased physical activity which can help increase testosterone production naturally over time.
It may take several weeks for these interventions to have an effect on T levels so regular monitoring is necessary when using TRT or supplement therapies in order to avoid side effects such as acne or gynecomastia due to high doses of hormones being taken over extended periods of time.
Additionally, psychological therapy can be used in some cases where anxiety or depression are thought to be contributing factors in low T levels.
Once diagnosed with low testosterone, it’s important that you seek treatment right away because untreated hypogonadism can lead to significant health issues over time including osteoporosis, heart disease and infertility in extreme cases! Luckily there are several ways in which you can treat this condition:
Diet & Exercise Plan
By eating healthier foods high in healthy fats like Avocados, Omega 3 fatty acids found in fish and nuts coupled with regular exercise routine consisting mainly weight training + aerobic workouts 3x week minimum will not only help increase muscle mass but also boost overall energy levels reducing fatigue making daily tasks easier!
Alongside this making sure enough sleep hours are had nightly (7-8 hrs) should also positively improve mood swings associated w/hypogonadism given proper rest gives our brains enough recovery time from stressful events thus preventing anxiety peaks overall helping reduce depression further if present!
Hormone Replacement Therapy
This involves using artificial hormones called Anastrozole or Exemestane which work by blocking estrogen production while stimulating natural production of testosterone within your own body thus increasing total hormone levels again over time gradually reducing any symptoms caused by decreased amounts before any real damage was done!
Depending on severity different doses might be prescribed but generally taking 1 pill daily should suffice eventually returning your levels back near normal ranges after roughly 6 months usage when monitored closely through regular doctor checkups during treatment alongside dieting/exercising regularly too!
Taking Testosterone Boosting Supplements
The most common, effective, safer and affordable option to boost testosterone levels is taking testosterone boosting supplements. The best testosterone booster supplement contains natural ingredients including minerals, vitamins and herbs that are clinically tested for testosterone boosting results.
These testosterone boosters are 100% safe and don’t include any artificial hormone, steroid or banned stimulant for short-time results.
Low testosterone, or ‘low T’, is a condition that affects men of all ages and can lead to a variety of health problems. Testosterone is responsible for the formation of masculine characteristics such as muscle mass and facial hair and is also important in fertility.
When testosterone levels are low, men may experience symptoms like fatigue, decreased sex drive, depression, irritability and others. There are also various forms of diagnosis and treatment available for low T.
In conclusion, Low Testosterone is a condition that affects many men across various age ranges with varying degrees of severity dependent upon individual circumstances. There are both physiological symptoms as well as psychological effects associated with this condition which can lead to reduced quality of life if left untreated for extended periods of time.
Diagnosis usually involves blood testing but should always be done with direct consultation from a healthcare professional for accuracy purposes prior to any form(s) of treatment being considered viable options for addressing the issue at hand long-term via medication therapies or lifestyle modifications depending on each individual case scenario best suited based upon results from said diagnostic process(es).
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