Thought Leadership

New Perspectives To Improve the Credentialing Industry

Category: Case Study

University of Pennsylvania Health System – Academic Medical Center

The University of Pennsylvania Health System (Penn Medicine) is a world-renowned academic medical center dedicated to discoveries that advance science, outstanding patient care throughout the world, and the education of physicians and scientists who carry on its legacy of excellence. The organization has nearly 2,000 physicians between its primary care network and faculty practice plan.… Read More

The University of Pennsylvania Health System (Penn Medicine) is a world-renowned academic medical center dedicated to discoveries that advance science, outstanding patient care throughout the world, and the education of physicians and scientists who carry on its legacy of excellence. The organization has nearly 2,000 physicians between its primary care network and faculty practice plan.

Like many faculty practice plans and physician organizations that have evolved over the years, Penn Medicine had created and maintained a large number of tax IDs. Greater than 30 different tax IDs were in use with all of the revenue ultimately being owned by the Trustees of the University of Pennsylvania. With the significant increase in Electronic Medical Record (EMR) integration along with increasing regulatory requirements focusing on quality (Meaningful Use, Value Based Modifier, etc. ), the existing structure no longer works. Reporting patient services under different tax ID’s did not properly reflect Penn Medicine’s integrated approach to the care they provide their patients.

Penn Medicine was faced with the enormous undertaking of paring down its faculty practice plan tax ID numbers from 32 to one and needed additional and experienced resources to complete the task within the desired timeframe. Penn Medicine partnered with Newport Credentialing Solutions to manage and complete the task.

Highly experienced staff provides necessary resources

Familiar with Newport and its reputation for excellence in credentialing and provider enrollment, the Senior Director of Patient Accounting at Penn Medicine, Steven Honeywell, enlisted Newport’s services. The project began in February 2015, and needed to be affective with dates of service starting May 1st 2015.

Newport’s deep knowledge of the provider enrollment process and established relationships with payer groups proved to be a huge asset for the project. The consolidation required Newport to work with Penn Medicine’s large number of payers (including Medicare, Independent Blue Cross and all other Blues Plans, Aetna and many others). Newport was involved in the process to create new national provider identification numbers (NPIs) and make sure the group NPI’s and Physicians were correctly associated with our designated tax ID number.

The project was a massive undertaking that required diligent follow-up. If NPIs were not set up correctly in the payers’ systems, the claims would go unrecognized, and potentially not paid. The team at Newport has proven they have the knowledge, the resources, and the follow-through to meet the demands of this cumbersome task.

According to Honeywell, to undertake a project of this size internally Penn Medicine would have had to hire additional staff specifically for the duration of the project. Even with the added resources, without the knowledge and experience that Newport’s staff brought to the table, it would have taken the Penn Medicine team significantly longer.

Spotlight Quote: “Newport brought the much-needed resources and expertise necessary to handle this very demanding project. They work with payers every day along with our internal resources. They know the right contacts at the payers, and they know how the provider enrollment industry works. The staff at Newport are great to work with and very diligent with follow-through. It is clear they know their stuff, and I could not be more pleased with the services Newport provides,” concluded Honeywell.

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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,… Read More

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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1DocWay – Independent Physicians

1DocWay provides telepsychiatry services to hospitals and clinics wanting to increase provider access and create new revenue streams. Trusted by approximately 35 clinicians, psychiatrists and psychologists, the company has delivered more than 22,000 telepsychiatry encounters in 11 states. 1DocWay expects to add 70 new physicians over the next year, so managing the credentialing process in-house… Read More


1DocWay provides telepsychiatry services to hospitals and clinics wanting to increase provider access and create new revenue streams. Trusted by approximately 35 clinicians, psychiatrists and psychologists, the company has delivered more than 22,000 telepsychiatry encounters in 11 states. 1DocWay expects to add 70 new physicians over the next year, so managing the credentialing process in-house is no longer feasible.

Previously 1DocWay relied on one full-time staff member to manage its credentialing process. This person handled credentialing, state licensing, health plan enrollment and more. As the practice grew with the addition of several new physicians each month, the process quickly became unmanageable. Even with the help of additional staff members, the credentialing requirements were much more than the staff at 1DocWay were equipped to handle. 1DocWay realized that outsourcing was a much easier and more cost-effective option.

Proven Processes and Highly Experienced Credentialing Staff

Finding the right credentialing company proved harder than the management team at 1DocWay anticipated. While Internet searches revealed quite a few credentialing companies that focus on state licensing and some that focus on hospital credentialing and privilege, finding a credentialing company that manages health plan enrollments was a much more difficult task. With three potential companies identified, the interview process began. Despite their claims, it was immediately clear that two of the credentialing companies had very limited knowledge of the health plan enrollment process; their ideas, protocols and pricing models did not make sense. However, Newport Credentialing Solutions proved to be a different story.

“After speaking with the team at Newport it was immediately clear they know the credentialing business, and they know health plan enrollments. This is exactly what we were looking for in a credentialing partner. Newport has an affordable price model and a very efficient, well thought out process for getting new physicians enrolled and managing them going forward,” commented Phil Hirsch President, Health Services Division for 1DocWay.

Simplifying the Credentialing Process

Newport’s credentialing services were initially sought to help 1DocWay with the new service line that was joining its telepsychiatry network. The plan to onboard this vast healthcare delivery system is a phased addition of physicians. Seven licensed psychiatrists were first to join, with additional psychiatrists to be added to the 1DocWay telepsychiatry network each month. For every doctor, there are approximately 15 health insurance companies. Each physician must enroll in each of the 15 health plans. The applications are cumbersome and time consuming. Working with the team at Newport Credentialing, what would have been an impossible task to manage in-house is now only a matter of providing the physicians’ names, some background information and copies of documentation. The team at Newport takes care of the rest.

With information in-hand, Newport adds the physician data into its cloud-based software program and can then quickly populate the information into all of the required health plan applications. Newport proactively monitors all outstanding applications and conducts any necessary follow-up needed to ensure the enrollment process moves along as quickly as possible.

According to Hirsch, “The telemedicine practice is different than a brick and mortar practice. Therefore, it requires various processes. The team at Newport took the time to listen to our unique needs, they picked up new concepts quickly and were patient when explaining things to staff at 1DocWay which made for a smooth transition. We couldn’t be more pleased with the credentialing services they are providing.”

Maximizing Revenue

Rapid growth at 1DocWay is expected to continue for the foreseeable future as more physicians take advantage of the benefits telepsychiatry has to offer. Previously this would have required a significant expansion of internal staff to keep up with the back office and administrative functions needed to manage the credentialing process. By outsourcing credentialing to Newport, 1DocWay has eliminated the need to hire additional staff to handle to its growing telepsychiatry network.

Other financial benefits have been achieved by significantly reducing denied claims. Prior to utilizing Newport’s services, denied claims were a significant issue when physicians believed to be in the network were not. Despite a disclaimer on its financial forms stating the patient is responsible for the full cost of service in the event the physician is out of network, 1DocWay does not believe in burdening patients with unexpected charges. Therefore, 1DocWay takes the hit. With Newport, there are no more costly out of network surprises.

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FOX Rehabilitation – Non-Physician Providers

FOX is a private professional practice of physical, occupational, and speech therapists that provide proactive, evidence-based rehabilitation services in the home and senior living community settings. This rapidly growing practice has more than 850 clinicians in nine states. Previously FOX’s credentialing was handled in-house. A manager and two specialists handled the entire credentialing lifecycle including all… Read More

FOX is a private professional practice of physical, occupational, and speech therapists that provide proactive, evidence-based rehabilitation services in the home and senior living community settings. This rapidly growing practice has more than 850 clinicians in nine states.

Previously FOX’s credentialing was handled in-house. A manager and two specialists handled the entire credentialing lifecycle including all new enrollments, re-validations, re-certifications, and any new group establishments with various plans. Without system capabilities in-house and adequate staffing, it became increasing difficult for the staff to manage and maintain the credentialing process. FOX quickly realized that outsourcing was a much easier and more cost-effective option.

The credentialing company FOX initially selected offered a very appealing low price tag but quickly fell short of FOX’s expectations. After transitioning the entire function to Newport Credentialing Solutions, FOX now has a highly trained staff that can keep up with the company’s rapid growth.

A Collaborative Effort Helps Streamline Processes

The transition to Newport was very easy. After a meeting between staff, Newport developed all of the processes which were tailored to address FOX’s unique requirements. It was a collaborative effort that went very smoothly; Newport listened to FOX’s requests and made things happen with no hesitation.

The relationship between FOX and Newport is a real partnership. A Newport representative is onsite up to three days per week managing all of FOX’s new providers (FOX averages 20 new hire clinicians a month). The FOX liaison handles gathering all information necessary to make a completed packet for enrollment; Newport takes over all enrollment processes from there.

“The biggest benefit of our Newport relationship is the resources to keep up with FOX’s rapid growth and highly demanding credentialing requirements,” said Neil Weisshaar, VP of Information Systems at FOX Rehabilitation. “There is a sense of security in knowing that our credentialing process is in excellent hands. Newport’s staff is highly trained and skilled which means we can focus our energy on other aspects of the business.”

Expert Staff Eliminate Resource Constraints, Save Money

Since partnering with Newport, FOX was able to reduce the number of personnel needed to manage credentialing. Only one coordinator remains, serving as the liaison between Newport and the practice. Newport handles all credentialing processes. As a result, the administrator can provide additional resources to other areas of the practice in addition to her vendor relationship role. Cost savings were achieved through the elimination of two positions.

An unexpected benefit of outsourcing is the elimination of seasonal staffing issues. Because credentialing is a process that temps cannot fill, staffing obligations fall short when someone is on vacation. An outsourced billing partner, on the other hand, has to maintain a certain level of service no matter what the season.

“I am a huge proponent of outsourcing having witnessed the benefits of it first hand. Of course having the right partner is essential, and we’ve found that with Newport,” said Lina Monterosso, VP Revenue Management at FOX Rehabilitation. “The staff at Newport took the time to understand our business and the unique workflow of FOX and developed a program that meets our particular needs. Their staff knows credentialing and are on top of everything, which means one less thing we have to worry about.”

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Provider Enrollment Case Study

Increased Revenue Through Pro-Active Provider Enrollment In today’s complicated healthcare environment, it is critical that providers capture every billable dollar. Pro-active management of your revenue cycle, implementing an ACO based physician alignment program, and keeping up with the increased provider enrollment requirements and processing times is key to maintaining a healthy bottom line. One area… Read More

Increased Revenue Through Pro-Active Provider Enrollment

In today’s complicated healthcare environment, it is critical that providers capture every billable dollar. Pro-active management of your revenue cycle, implementing an ACO based physician alignment program, and keeping up with the increased provider enrollment requirements and processing times is key to maintaining a healthy bottom line.

One area where providers lose revenue is provider enrollment. Application processing, tracking, and diligent follow-up is difficult to manage and many providers don’t realize that a successful provider enrollment initiative needs to be a pro-active provider enrollment initiative. Additionally, providers are realizing that they can generate incremental revenue by reducing provider enrollment timeframes as well as enrolling allied health providers.

At Newport, we believe that provider enrollment is a critical part of the revenue cycle. As such, provider enrollment followup needs to be handled in the same way that accounts receivable (AR) follow-up is conducted. Follow-up needs to be standardized and systematic. The following Case Study provides an example of how Newport’s pro-active provider enrollment follow-up generated incremental revenue for a Newport client.

The Problem: Client was losing revenue due to not enrolling its Physician Assistants

  • Client was interested in generating additional revenue by enrolling their Physician Assistants
  • Client had 200 Physician Assistants which were not being billed as stand alone providers
  • Client looked at a number of internal and external provider enrollment options to process and manage the large provider enrollment initiative
  • Client had limited internal resources (staff and physical space) and wanted to start the project ASAP

The Solution: Client received a 10 to 1 ROI for Net New Providers

  • Newport initiated a comprehensive provider enrollment solution for all 200 Physician Assistants
    • Transition Kick Off Meeting
    • On-Site Documentation Collection
    • Built all Provider Profiles in our Credentialing System
    • Conducted Weekly Review of Missing Elements Document
    • Packaged Applications and Signature Packets
    • Distributed and Collected Signature Packets from Providers
    • Submitted all Applications (CAQH, Non-CAQH and Delegated)
    • Conducted Bi-Weekly Application Follow-up
    • Reviewed Advanced Reporting to Highlight Process Breakdowns and to Track and Trend all Outstanding Items
    • Conducted Weekly On-Site Account Management Meetings
  • Client was able to bill for Physician Assistants as an individual provider translating to substantial incremental revenue for the organization

 

About the Author

Scott T. Friesen is the CEO of Newport Credentialing Solutions and has over 12 years of healthcare experience in the hospital and faculty practice setting.

About Newport Credentialing Solutions

Newport Credentialing Solutions is the nation’s premier provider of cloud based software and IT enabled services dedicated to the credentialing life cycle. Newport provides cloud based workflow, analytics, and business intelligence credentialing software and IT enabled credentialing services to some of the largest academic medical centers, health systems, and multi-­‐‑ specialty group practices in the United States. Newport helps clients “Take Control” over their credentialing life cycle by streamlining operations, reducing credentialing related denials, and generating more cash for their organization.

For more information on Newport’s software and service solutions, please contact 516.593.1380 or info@newport.theadleaf.com.

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Cooper University Health Care

Cooper University Health Care partners with Newport Credentialing Solutions and receives 400% ROI by implementing cloud based analytics and IT enabled credentialing services The Problem: Lost revenue due to lack of centralization and effective credentialing software Like most rapidly growing healthcare systems, Cooper University Health Care (Cooper) struggled with their provider enrollment. Due to aggressive… Read More

Cooper University Health Care partners with Newport Credentialing Solutions and receives 400% ROI by implementing cloud based analytics and IT enabled credentialing services

The Problem: Lost revenue due to lack of centralization and effective credentialing software

Like most rapidly growing healthcare systems, Cooper University Health Care (Cooper) struggled with their provider enrollment. Due to aggressive provider on-boarding and system-wide growth, staff were overwhelmed with the high volume of new providers who were coming on board. With inadequate provider enrollment software, and a staff struggling to stay on top of new provider enrollment, as well as existing provider maintenance, Cooper’s provider enrollment edits were growing at an alarming rate causing increased write offs and lost revenue. Clearly, something needed to change.

Cooper partnered with Newport Credentialing Solutions (Newport) to proactively manage their credentialing needs. Newport provides cloud based software and IT enabled credentialing services to some of the largest health systems and academic medical centers in the country. Newport’s cloud based software and IT enabled services provide a highly flexible and revenue centric suite of solutions to help clients “Take Control” over their provider credentialing.

The Solution:Cloud based reporting software and IT enabled credentialing services to improve
revenue and accountability

After meeting with the Cooper team to understand their credentialing challenges, Newport implemented their IT enabled credentialing services. Because of Newport’s in-depth experience working with large health systems and teaching hospitals, Newport was able to immediately offer highly differentiated value through their centralized, cloud based software and on-site account management. “Newport immediately partnered with our revenue cycle and medical staff teams to identify un-enrolled providers and revenue improvement opportunities,” said Charles Reitano, VP of Revenue Cycle for Cooper. “The combination of Newport’s highly experienced on-site account managers and centralized IT enabled services quickly triaged our enrollment department and set out to implement system wide improvements. Newport served as a true partner in helping us quickly and efficiently reduce our credentialing edits and generate incremental revenue for our organization” said Reitano.

Newport made the transition for Cooper seamless by conducting a comprehensive, onsite data collection process. Once Newport collected all of Cooper’s data, Newport quickly built provider specific profiles in their cloud based system and began a comprehensive par/non-par analysis. “The par/non-par analysis is critical to any engagement because it establishes an enrollment baseline from which all other activities occur,” said Kenny Bergman, COO of Newport Credentialing Solutions. “Often, clients don’t have the bandwidth to conduct this revenue critical analysis, so Newport conducts an exhaustive par/non-par analysis as part of every engagement.

By utilizing cloud based technology, Newport is able to ensure that every provider is enrolled at every location and therefore are not losing system wide revenue due to enrollment lapses” said Bergman.

After completing the par/non-par analysis, Newport worked closely with Cooper’s revenue cycle and medical staff services offices to target providers with high credentialing related edits and denials. “Newport’s ability to work and adjudicate our credentialing related edits played a significant role in the rapid reduction in overall edits and write offs” said Francine Bargeron, Director of Professional Fee Billing. “The Cooper and Newport teams worked seamlessly together to identify providers who were not enrolled, enroll those providers, and adjudicate all outstanding edits and denials.” Further, Newport’s cloud based reporting software, CAREreport, provided the in-depth clarity that we needed to further improve the overall process.”

Outcomes:Significantly reduced credentialing edits driving increased revenue

From the start of the engagement, Newport exceeded Cooper’s expectations. By partnering with Cooper’s revenue cycle and medical staff office teams, Newport was able to reduce Coopers credentialing related edits by 68% in the first 12 months and by 90% in the first 24 months. The 98% improvement in credentialing related edits translated in $1.5M in incremental revenue to Cooper’s bottom line. “Cooper’s partnership with Newport has provided tremendous financial benefit to Cooper. Their use of cloud based reporting and analytics, deep provider enrollment expertise, and extensive payer contacts has helped our provider enrollment department evolve into an integral part of the revenue cycle and further enhance our highly performing organization” said Reitano.

“Newport’s mission is to provide our clients with industry defining, revenue centric, cloud based and IT enabled services which help them “Take Control” over their credentialing life cycle. Everything that Newport does is laser focused on helping our clients improve performance in a rapidly evolving healthcare environment,” says Kenny Bergman, COO of Newport.

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Are You Sure You Are Capturing Every Collectable Credentialing Dollar?

Patrick Doyle, Newport VP of Business Development, shares the importance of viewing your Provider Enrollment Department as a critical part of your revenue cycle. Q. Why is it important for hospitals and health systems to view provider enrollment as a critical component of their revenue cycle? A. One way hospitals and health systems can improve… Read More

Patrick Doyle, Newport VP of Business Development, shares the importance of viewing your Provider Enrollment Department as a critical part of your revenue cycle.

Q. Why is it important for hospitals and health systems to view provider enrollment as a critical component of their revenue cycle?

A. One way hospitals and health systems can improve their financial performance is by assessing their Department of Provider Enrollment. Hospitals and health systems are spending so much of their time preparing for payment reform and population health management, that they overlook the importance of ensuring that once hired the provider, they then need to rapidly and accurately enroll that provider with all of their payers.

Q. What is the impact of not enrolling their provider with their payers?

A. Lost revenue. When organizations implement the right provider enrollment strategy, they ensure that they are capturing every dollar. Hospitals and health systems need to have tools in place to identify the financial risk of their “In-Process” provider enrollment applications. One way to do this is to use technology to link a provider(s) gross charges to their “in-process applications.” This allows them to triage their At Risk dollars, and focus their enrollment activities on those providers with the greatest number of dollars associated with their in-process applications first. After working their greatest at risk providers, they can then focus on those providers with fewer dollars associated with their in-process applications.

Q. What are the steps involved in realizing these gains?

A. Executive, physician, and management engagement is critical. Hospitals and health systems have to implement the right technology tools that have the ability to track “at-risk credentialing dollars.” Further, they have to have the right metrics and a way to share them in real-time.

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