Can a New Provider Start Seeing Patients Without Credentialing?

Can a New Provider Start Seeing Patients Without Credentialing?

Starting a medical practice or joining an existing one as a new provider brings excitement, hope, and a fair amount of challenges, especially when it comes to credentialing. One of the most common questions asked by doctors, nurses, and healthcare practitioners entering the field or transitioning to a new setting is: Can I start seeing patients before I’m fully credentialed?

This article explores the fears, goals, and practical solutions around this issue while emphasizing how Medical Billing Services for Small Practices and Healthcare Billing Services play a crucial role in smoothing out the process.

The Credentialing Challenge: Why It’s a Big Deal

Credentialing is the process of getting a provider approved by insurance companies so they can bill and receive reimbursement for services rendered. It includes verifying education, training, experience, and licensing. The process is thorough—and slow. It may take anywhere from 60 to 180 days or more.

For a new provider, this delay poses serious concerns:

  • Loss of income during the waiting period.

  • Patient care disruptions, as new appointments must be scheduled far in advance.

  • Operational hiccups for small or growing practices relying on new providers to handle the patient load.

  • Stress on existing providers who carry the burden of seeing more patients.

Understandably, practices want solutions that allow providers to start seeing patients immediately—even if they’re not credentialed yet.

The Goals: What Healthcare Practitioners Want

Every practice or provider entering a new phase has common goals in mind:

  • Deliver timely patient care without delays due to paperwork.

  • Optimize practice revenue even while waiting for credentialing approval.

  • Stay compliant with payer and federal regulations.

  • Minimize claim denials and write-offs.

  • Focus on patient outcomes, not administrative barriers.

To meet these goals, practices often turn to strategic approaches involving Medical Billing Services for Small Practices and experts who understand the healthcare system inside and out.

Can Providers See Patients Without Being Credentialed?

The short answer is yes—but with conditions. There are legal and compliant ways to work around full credentialing in certain scenarios. Here's how:

1. Incident-To Billing (Medicare Specific)

For non-physician practitioners (like NPs and PAs), services can be billed under a supervising physician's NPI under Medicare’s "incident-to" billing rules. However, these services must follow strict criteria:

  • Services are part of the physician’s plan of care.

  • The supervising physician must be present in the office suite.

  • The patient is an established patient with an established problem.

This allows the practice to get reimbursed while staying compliant.

2. Locum Tenens Arrangements

In some cases, practices can bring in a substitute physician under a locum tenens arrangement (primarily for Medicare). This is a temporary solution for up to 60 days and must meet specific conditions.

3. Cash-Pay or Self-Pay Patients

Providers can see patients who are willing to pay out-of-pocket. However, this means the patient will not be able to submit claims for reimbursement from insurance plans, which may limit your practice’s accessibility.

4. Retroactive Billing (With Limitations)

Some insurance plans offer retroactive credentialing, meaning once you're approved, you can bill for services provided during the application process. Be cautious—each payer has different policies, and this is not guaranteed.

The Role of Billing Services: A Game Changer

Handling the credentialing process and billing complications is no small feat. That’s where Medical Billing Services for Small Practices become critical. These services take on the burden of credentialing follow-up, insurance coordination, and clean claim submission.

At P3 Healthcare Solutions, we offer Healthcare Billing Services tailored to small and mid-sized practices. Here’s how we support new providers:

  • Credentialing Support: We assist in preparing, submitting, and tracking credentialing applications to speed up approvals.

  • Eligibility Checks: Verifying insurance coverage upfront prevents claim denials.

  • Pre-bill Audits: Ensuring that services billed under a supervising provider’s NPI are fully compliant.

  • Claims Management: From submission to denial management, we handle every stage to keep your revenue flowing.

  • Consulting on Billing Structures: We help you understand legal ways to see patients while waiting for credentialing.

Why Choose P3 Care?

P3 Healthcare Solutions is more than just a billing company—we’re a trusted partner in your practice’s success. Here’s what makes us the right choice:

  • Customized Solutions: Our team provides Medical Billing Services for Small Practices with flexibility to fit your unique needs.

  • Compliance-Focused: We ensure that all billing practices follow federal, state, and payer-specific rules.

  • Speed and Accuracy: Fast credentialing and accurate billing reduce revenue lags and administrative headaches.

  • Dedicated Support: From the moment you join us, our account managers and credentialing specialists are just a call away.

  • Results-Oriented: Our mission is to maximize your revenue while keeping your focus on patient care.

With our robust Healthcare Billing Services, your practice doesn’t have to pause its growth or compromise on compliance.

Final Thoughts

Starting out as a provider or hiring a new one shouldn’t be delayed by red tape. While credentialing is essential, there are compliant and strategic ways to keep your practice operational and profitable in the meantime.

With expert support from Medical Billing Services for Small Practices, you can focus on treating patients while we handle the back-end complexities. Whether you're a physician, nurse practitioner, or surgeon, having a reliable billing partner like P3 Healthcare Solutions can make all the difference.

Read more: What Are the Advantages of Outsourcing Medical Billing?

Need Help Getting Started?

If you want more information, kindly get in touch with us.
Call us at: (844) 557–3227
Address: 3200 E Guasti Rd Suite 100, Ontario, CA 91761, United States
Visit our website: www.p3care.com

Location: United States

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