Medical Billing

# Why is State Medical Licensing Essential for Medical Billing?

- May 27, 2024
- Posted by Kristen Edwards

14 Mar

In the healthcare system, physicians and institutes remain concerned about the quality of care given to patients and reimbursement of bills for the services they provide. This medical billing process seems more complicated than simple. A medical license is essential for physicians to proceed with the medical billing process.

An important aspect that is mostly overlooked is the need for healthcare providers to have particular medical licensing in their states of practice. State medical licenses hold specific importance in the medical billing process. Medical credentialing is the only process for getting this medical license to comply with the billing process from the insurance companies.

In this article, we will learn about the state medical license, its importance, and the process of getting these state medical licenses.

## Understanding of Medical Licensing

Medical licensing is used by the states in the United States to legally authorize people to deliver the medical services they offer within specific geographical areas. This issues the license of the licensing board of the State, and it can change from State to State as requirements and regulations are different in different states.

Certain states have developed agreements that enable the streamlining process to keep the same standards for physicians who want to practice in more than one State. As another instance, the Interstate Medical Licensure Compact already has 29 states united under state law.

When a practitioner has the license to work in just one State, they are not allowed to practice medicine in any state where they do not hold the license. On the other hand, if they would like to settle in one of the neighboring states, they could apply for a license modification to the address in the one they intend to move to. Implementing the above factors for a state medical license is essential because it is a long and tedious process, and physicians would only want to do it a few times.

## Who Needs Medical Licensing?

In the United States, anybody who relies on a medical license to practice medicine is supposed to have already obtained such a license. It is worth noting here that the physician’s role is not the only one the rule applies to in the healthcare system, like other healthcare providers and certain medical services. These include:

- Physicians
- Psychologists
- Couple, relationship, and family therapists.
- Professional clinical counselors
- Physician assistants
- Nurse practitioners
- Psychiatrists
- Social workers

Each state has its own requirements and prerequisites to be satisfied to get a medical license. Nevertheless, in most cases, this is manifested upon the applicant presenting a resume, proof of educational credentials, training, working history, references, proof of general health and eligibility to practice, any cases of malpractice/settlements, as well as having a criminal record check.

## Importance of State Medical Licensing in Medical Billing

State medical licensing is essential for medical billing for several reasons:

### Legal Requirement

The state medical licensing arrangement enables healthcare providers to fulfill the legal requirements and practice in that particular State. A healthcare provider must have a valid medical license to provide medical services to patients and get an installment of billing for the qualified services.

Healthcare providers are recommended to stick to the guidelines provided by the licensing boards and state health departments to practice medicine effectively in their desired State.

### Credentialing

One of the most common requirements for state medical licensure is the credentials for healthcare providers to be recognized on a third-party payer level, be it an insurance company or any other. Medical credentialing involves establishing and revising a healthcare provider’s requirements, examination, and licensing to prove that the provider meets the set payer’s standards. Properly credentialed physicians have the privilege of getting medical bills cleared in a timely and have the full right to use legal ways in case of delay or no reimbursement paid by the insurers.

### Compliance

Having a state’s licensing ensures that medical practitioners abide by the laws and federal laws that govern the practice of medicine in the State. Medical billing and coding professionals should observe and comply with the instructions and the rules, not just in the billing and coding but also in their privacy and ethics. In case of state laws or medical credentialing process violations, healthcare providers may have to face penalties and punishments.

## Professional Accountability

State licensing for medical practice results in the accountability of decisions and actions of healthcare professionals. Healthcare persons who are licensed should abide by the ethical principles and provisions stipulated by the health practice guidelines. This comprises maintaining patient privacy through measures such as not disclosing private details to the public while following procedures such as obtaining informed consent and providing care that is in the patient’s best interest. This shows that healthcare providers pay attention to integrity, which guarantees a patient’s well-being.

### Quality of Care

Patient quality of care is another factor that connects state medical licensing to the quality of the work done by healthcare providers. Most licensing regulations consist of finishing medical education and successfully taking a final licensing exam for providers that ensures they have the appropriate knowledge and skills to provide exceptional healthcare.

With this in mind, more attention should be paid to the medical coding accuracy and efficiency reflected in the proper billing. Such development can, consequently, affect the precision and success of medical billing.

## How long does it take to obtain medical licenses?

Generally, applicants need to wait significantly longer for the license approval process, which may depend on the required levels of experience and skill. Usually, it takes a long period as one application counts many details that must be 100% tabulated. As for every inaccuracy or missing information, it could lead to more delays; thus, obtaining an accurate and complete application is crucial in this case.

It is an official recommendation of the American Medical Association that the applicants be aware of waiting at least two months from the moment they submit their application to the date the license will be granted. Nevertheless, it shows the average time frame to turn over the order. Certain states are credible for faster turnaround times, such as Colorado, within 30 to 60 days. Nonetheless, it should not be your basis for determining the timetable for the license application process because issued duration times can vary greatly.

Additionally, regarding the renewal time of the licenses, different states dictate this according to their regulations. In some states, other than mandatory education courses, the physician is supposed to provide proof that they have been doing continuous education in their field during the renewal period of their licenses.

## Conclusion

State medical practice licensing obligates healthcare practitioners to be in the best state for the community to entrust them with the responsibility of providing healthcare services. These protocols guarantee that healthcare providers practice per the State’s medical board and meet the qualifying criteria for patient safety and healthcare quality. Medical licensing holds great significance to patients with regard to the quality and safety of the care they receive in hospitals.

The results of denying the proper licensing may turn out to be serious, including legal issues, insurance paying problems, patient safety, and moral problems. As such, it is crucial for healthcare providers to have a state license and to meet all licensing demands according to medical credentialing rules to make the medical billing process smooth and error-free.

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