Getting Credentialed In Optometry – Common Questions

This is a sponsored post by Optometric Billing Consultants, a supporter of NewGradOptometry & new graduate optometrists! 😎

Getting credentialed in optometry is not an easy task.

Getting credentialed with various vision and medical plans can be a long and arduous process, ripe with confusion and of course frustration. Once you have finally completed the process, be it on your own, through your employer, or by utilizing some of the experts out there, you never have to worry about getting credentialed again! Right?

Maybe not!

As we all know your job situation can and likely will change at some point during your career. How does that affect your credentialing status? Do you need to take any particular measures?

In this article, we will examine some of the most common challenges, questions, and hurdles associated with getting credentialed in optometry either for the first time or after making a job change!

Read more on the nuts and bolts of getting credentialed.

Medicare – How do I handle this?

If you read our beginners guide to getting credentialed in optometry, this was probably the first insurer you applied to be a provider for. Chances are, it might also be the first insurer you attempt to amend your credentialing status with.

When can I start seeing patients with Medicare?

You can begin seeing patients per your “effective date.” The effective date is the date that you requested when the application was submitted. However, you cannot submit claims until you receive an official approval letter.

What is the difference between a participating provider and a non-participating provider?

The main difference between a participating provider and a non-participating provider under Medicare is that the participating provider accepts the fee assignment and the non-participating provider does not.

Things to consider:

  • A different fee amount is charged between participating and non-participating providers.
  • Medicare chooses to pay a different amount to each designation.
  • Medicare sends the payment to the doctor instead of the patient when the doctor is a participating provider, and to the patient when the doctor is non participating.

Here is an in-depth guide on getting credentialed with Medicare.

If I am already credentialed as a sole proprietor and decide to incorporate, what happens next?

Several of the insurances will require re-credentialing for the new Tax ID. Medicare definitely will. When handling this for clients, I will always call to see if we can simply add a Tax ID, or if we have to re-credential. It varies by insurance and by state.

If I am already credentialed on my own, and decide to open a second practice location, do I need to get re-credentialed for the new location?

So long as it is the same Tax ID number, you can just add a location for every insurance company.

If I am already credentialed, and decide to work as an employee for another practice, can I be added under the practice?

If you are credentialed and want to work for another company, as long as they are also providers, you can be linked to their contact, or with Medicare, and benefits can be reassigned. If this is your first employment as a new graduate, you should start working on getting credentialed as soon as you are licensed to reduce wait times.

What happens if I leave a practice? Do I need to let insurances know I am no longer working at those locations?

Not immediately. If you have claims out and you have already dropped your name from these locations, you might not receive payment for them!

If you have more questions about credentialing or need help with the process, feel free to contact Kenny Meyer at  Kmeyer@claimdoctor.net and he can help you get credentialed for both routine and medical plans.

About Eric Botts O.D.

Eric Botts O.D.
Eric K. Botts has a Doctorate of Optometry from Southern College of Optometry, is a Third Party Trustee for Illinois Optometric Association, the President of the Energeyes Association, the Founder & Doctor of InnovativEyes Clinic, and the Founder & CEO of OBC Insurance Billing and Credentialing Specialists. Dr. Botts is a very passionate and engaging speaker with decades of real-world experience. He has hosted well over 250 Continuing Education Courses to 1,000s of fellow ODs! Besides having distinguished credentials Dr. Botts is a family man who has 3 daughters with his wife Lori, and they reside in the Midwest town of Macomb, IL.

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