Thought Leadership

New Perspectives To Improve the Credentialing Industry

AtlantiCare – Hospital Employed Physicians

AtlantiCare Physician Group (APG) provides high-quality, convenient healthcare to communities throughout southern New Jersey. With more than 350 physicians, APG offers a full range of outpatient health services including urgent care, primary care, specialty care and occupational health.

This large and growing practice has more than 80 different billing areas comprised of primary care, group practices, anesthesia, behavioral health, neurosciences and more. Before utilizing Newport Credentialing Solutions’ software and services, APG relied on a billing company to handle its credentialing and provider enrollment processes in addition to other billing responsibilities. The company handled everything from Medicare enrollment to local governmental payers such as Medicaid and all commercial carriers. Their lack of experience in credentialing and enrollment coupled with internal process issues at APG resulted in significant non-payment issues. APG realized it was time for a change.

APG’s Director of Revenue Cycle at the time, Tony Cottone, was very familiar with Newport having worked with the company at another hospital. Based on his recommendation, APG agreed to a one-year trial period during which Newport exceeded APG’s high expectations. Now several years later, Newport continues to provide credentialing and provider enrollment services as well as cloud-based reporting to APG. Processes have vastly improved, revenue has increased, and APG remains very pleased with Newport’s staff and services.

Streamlining processes through automation

The billing vendor APG previously utilized relied on antiquated methods to manage their credentialing and enrollment. They relied on spreadsheets rather than a relational database such as Newport uses.

Data updated on spreadsheets had to be shared via uploading and updating on shared drives.  It was cumbersome and not real-time or easily reportable (like a relational database).  Tracking and prioritizing claims on hold by provider was not integrated and therefore more difficult to coordinate between

AtlantiCare and the billing company that was doing the credentialing. Today these processes are completely automated.

Using Newport’s cloud-based credentialing and provider enrollment software, APG staff quickly view provider status, claims on hold, etc. Reports are generated in real-time to show specific process details such as provider enrollment by payer group, practice locations(s), credentialing and provider enrollment status, NPI numbers and more. Using the system’s cloud-based feature, APG’s operations managers easily look at billing areas under their control and run reports themselves. The process is significantly easier and more streamlined than trying to maintain spreadsheets and loading data onto a shared drive as previously done.

Improved communication and a close working relationship

Internal process management improvements within APG, including greater communication between the recruiting department, medical staff, malpractice insurance, revenue cycle, and operations, have helped to improve processes.

Today APG has one person assigned as the vendor liaison. This person coordinates information from the physicians and feeds it back to the team at Newport who then take over all credentialing and provider enrollment responsibilities. Newport closely tracks automated claims on hold and vigorously works to pursue a resolution. Weekly phone conferences between the APG liaison and Newport staff ensure that everyone is up to date on enrollment and claim status. The relationship between APG and Newport is a true partnership.

According to Cottone, “Poor internal policies and inefficient processes led to lost revenue that equaled millions of dollars a year. After switching to Newport Credentialing Solutions and making internal process management improvements at APG, lost revenue is no longer an issue.”

Highly experienced staff and proven processes maximize revenue

The way healthcare is structured today, physicians have to be enrolled in a large number of plans to get paid. Depending on the insurance carrier, the enrollment process can take months. The billing system has to be set up, the credentialing process started, medical staff privileges verified and granted, malpractice insurance managed, the list goes on. The goal is to begin the process before the physician or allied health providers begin work at the hospital or medical group, and all of these tasks need to be managed based on specific insurance carrier rules. For example, some insurance carriers won’t allow certificates to be done until a week or two before the physician starts. However, having all the paperwork ready and the applications out in advance will minimize any unnecessary delays. If an insurance carrier takes 60 days to enroll a provider, things must be managed accordingly.

APG discovered that if processes are inefficient and inaccurate, there is a very high probability that significant revenue can and will be lost. However, using advanced technology, the staff at Newport know all of the payers and who’s who with the state Medicaid plans. The team at Newport have a system in place for Medicare registration and Medicare facility registration which is extremely valuable when managing the status of the applications.

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