Thought Leadership

New Perspectives To Improve the Credentialing Industry

Category: Q&A

RCM Tip of the Day: Automate CAQH Re-attestation Processes

As seen in Becker’s Hospital CFO Report: Written by Kelly Gooch Technology advances can help hospitals and health systems expedite the time they spend managing Council for Affordable Quality Healthcare re-attestation to credential providers, says Patrick Doyle, senior vice president at Newport Credentialing Solutions. Mr. Doyle shared this tip with Becker’s Hospital Review. “To maintain… Read More

As seen in Becker’s Hospital CFO Report: Written by Kelly Gooch

Technology advances can help hospitals and health systems expedite the time they spend managing Council for Affordable Quality Healthcare re-attestation to credential providers, says Patrick Doyle, senior vice president at Newport Credentialing Solutions.

Mr. Doyle shared this tip with Becker’s Hospital Review.

“To maintain provider enrollment CAQH re-attestation is required every 120 days for each provider. Advances in technology are enabling this process to be greatly streamlined. The ability to set automated reminders and alerts of pending re-attestation dates not only saves times, but eliminates the possibility of providers falling through the cracks.”
 
 
Click here to read the full article…
 
Becker’s Hospital CFO Report is the original producer of this publication.
 
 

RCM Tip of The Day: Don’t Underestimate the Importance of Participating and Nonparticipating Analysis

As seen in Becker’s Hospital CFO: Written by Kelly Gooch As hospitals seek to maximize revenue, it is crucial they conduct a participating and nonparticipating analysis to ensure their provider enrollment data corresponds to the enrollment data that the payers have recorded, according to Patrick Doyle, senior vice president of Lynbrook, N.Y.-based Newport Credentialing Solutions.… Read More

As seen in Becker’s Hospital CFO: Written by Kelly Gooch

As hospitals seek to maximize revenue, it is crucial they conduct a participating and nonparticipating analysis to ensure their provider enrollment data corresponds to the enrollment data that the payers have recorded, according to Patrick Doyle, senior vice president of Lynbrook, N.Y.-based Newport Credentialing Solutions.

Mr. Doyle shared the following tip…

Click here to read the full article…

Becker’s Hospital CFO is the original producer of this publication.

RCM Tip of The Day: View Provider Enrollment as a Critical Part of Your Revenue Cycle

As seen in Becker’s Hospital CFO: Written by Kelly Gooch Provider enrollment with payers is crucial, as it ensures proper reimbursement for services rendered, according to Patrick Doyle, senior vice president of Newport Credentialing Solutions. Mr. Doyle shared the following tip with Becker’s Hospital Review: “To ensure every collectible dollar is received, provider enrollment must… Read More

As seen in Becker’s Hospital CFO: Written by Kelly Gooch

Provider enrollment with payers is crucial, as it ensures proper reimbursement for services rendered, according to Patrick Doyle, senior vice president of Newport Credentialing Solutions.

Mr. Doyle shared the following tip with Becker’s Hospital Review: “To ensure every collectible dollar is received, provider enrollment must become an integral part of the revenue cycle process. Best practices should include…

Click here to read the full article…

Becker’s Hospital CFO is the original producer of this publication.

DOWNLOAD: The Invisible Impact of Credentialing

Are you aware of the impact credentialing can have on your healthcare facility? In Newport’s latest eBook, The Invisible Impact of Credentialing, we help bring awareness to the many invisible “touches” credentialing has on technology, patient satisfaction, revenue enhancement, and much more. The eBook is packed with actionable items you can start implementing today to… Read More

Are you aware of the impact credentialing can have on your healthcare facility?

In Newport’s latest eBook, The Invisible Impact of Credentialing, we help bring awareness to the many invisible “touches” credentialing has on technology, patient satisfaction, revenue enhancement, and much more. The eBook is packed with actionable items you can start implementing today to make a positive change at your facility.
 
Click Here to Download Now!

 
 
 
 

The Invisible Impact of Credentialing: Tip 4

Tip 4: Consider Overlooked Costs. Denied claims caused by credentialing-related issues have an obvious impact on a provider’s reimbursements. With limited exception, the inability to collect on these denied claims often leads a provider’s practice to write off the claim and stop the pursuit of reimbursement. Given just how many patient encounters a provider has… Read More

Tip 4: Consider Overlooked Costs.

Denied claims caused by credentialing-related issues have an obvious impact on a provider’s reimbursements. With limited exception, the inability to collect on these denied claims often leads a provider’s practice to write off the claim and stop the pursuit of reimbursement. Given just how many patient encounters a provider has in a given day, week or month, the financial impact of having to write off an encounter can be significant.

Practices go to great lengths to ensure a patient’s insurance is verified well in advance of an encounter. If he or she isn’t covered, the procedure isn’t done. While the financial implications of having to write off an encounter are well known, it is surprising that many practices are overlooking another process equally as important as insurance verification – credentialing and provider enrollment verification. To change the way credentialing and provider enrollment are viewed, quantifying lost dollars is essential… [click here to download].

Looking for additional tips?

To download Tip 1, please click here.
To download Tip 2, please click here.
To download Tip 3, please click here.

 

The Invisible Impact of Credentialing: Tip 3

Tip 3: Prevent Surprise Medical Billing.   In 2016 a number of states across the US enacted laws aimed at shielding patients from surprise medical bills.These laws have been enacted to protect insured patients from surprise medical bills when services are performed by an out-of-network provider at an in-network hospital or outpatient services location covered… Read More

Tip 3: Prevent Surprise Medical Billing.

 
In 2016 a number of states across the US enacted laws aimed at shielding patients from surprise medical bills.These laws have been enacted to protect insured patients from surprise medical bills when services are performed by an out-of-network provider at an in-network hospital or outpatient services location covered in their health insurance plan or when a participating provider refers an insured patient to a non-participating provider. Surprise medical bills are most often associated with emergency care, when a patient has little to no say in their care-plan. Items may include ambulances, anesthesiologists, radiology, etc. Surprise medical billing can also occur when a patient receives scheduled care from an in-network provider.

When healthcare providers are not enrolled properly with one or more health plans in which they participate, or if they have inadvertently allowed their enrollment status to lapse, billing disruption is inevitable… [click here to download].
 
 

Looking for additional tips?

To download Tip 1, please click here.
To download Tip 2, please click here.

 
 

Upfront Provider Enrollment Verification Can Greatly Minimize Claim Denials

As seen in Becker’s Hospital CFO: Written by Patrick Doyle, Vice President, Newport Credentialing Solutions Insurance verification can have a significant impact on a hospital’s bottom line. This is why hospitals go to great lengths to ensure a patient’s insurance is verified well in advance of an encounter to avoid claim rejection. If the patient… Read More

As seen in Becker’s Hospital CFO: Written by Patrick Doyle, Vice President, Newport Credentialing Solutions

Insurance verification can have a significant impact on a hospital’s bottom line. This is why hospitals go to great lengths to ensure a patient’s insurance is verified well in advance of an encounter to avoid claim rejection. If the patient is not covered, the procedure is not scheduled.

Similar to when a patient does not have valid insurance and their claim is denied, a patient’s claim will also be denied if the provider is not properly enrolled with the patient’s insurance plan. Considering a provider can see easily 3-4 patients per hour on any given day, the financial impact of denied claims due to lack of provider enrollment eligibility checks can be significant. Yet despite the financial impact, upfront provider enrollment verification is rarely discussed or practiced within many healthcare organizations…
 
 
Click here to read the full article…
 
Becker’s Hospital CFO is the original producer of this publication.
 
 

Hidden Ways Hospitals Can Save Money

As seen in Becker’s Hospital Review: Written by Scott Friesen, CEO of Newport Credentialing Solutions 2017 is predicted to be a challenging year for health systems and hospitals around the country, according to a recent blog post by Deloitte. Increased financial pressures are expected due to changes to the payer mix, the move towards value-based… Read More

As seen in Becker’s Hospital Review: Written by Scott Friesen, CEO of Newport Credentialing Solutions

2017 is predicted to be a challenging year for health systems and hospitals around the country, according to a recent blog post by Deloitte.

Increased financial pressures are expected due to changes to the payer mix, the move towards value-based care and uncertainty over a new administration in Washington. For those who continue to operate business as usual, a sound financial future will be challenging, if not impossible, to achieve.

Traditional cost cutting measure like labor reductions and supply costs are no longer enough. Hospitals and health systems must look for new ways to reduce expenses and increase revenue. This requires…
 
 
As seen in Becker's Hospital ReviewClick here to read the full article…
 
Becker’s Hospital Review is the original producer of this publication.
 
 

Why is the Healthcare Industry Lagging Behind in Cybersecurity?

As seen in NetLib Security: Written by Scott Friesen and David Meier of Newport Credentialing Solutions and Jonathan Weicher of NetLib Security Although it might seem as of late that government agencies have become the prime target for hackers, both domestic and foreign, we must not lose sight of the healthcare industry. Health care data… Read More

As seen in NetLib Security: Written by Scott Friesen and David Meier of Newport Credentialing Solutions and Jonathan Weicher of NetLib Security

Although it might seem as of late that government agencies have become the prime target for hackers, both domestic and foreign, we must not lose sight of the healthcare industry. Health care data breaches are growing exponentially, according to a report released by the Government Accountability Office. While Anthem and Banner Health are two of the most notable breaches, a steady stream of healthcare breaches have since followed. Healthcare organizations of every size, patients and providers are all at risk. How severe is the situation? According to Scott Friesen and David Meier from Newport Credentialing Solutions, with whom I had the privilege to speak, “the threat is serious as the healthcare industry is significantly behind other industry’s when it comes to the field of cybersecurity, and only recently began playing catch up. As a result, healthcare organizations, patients and providers are all left vulnerable against today’s sophisticated attackers.”

Newport is a premier provider of cloud-based software and IT enabled services dedicated to the credentialing life cycle. The company provides cloud-based workflow, analytics 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. NetLib has been working with Newport for many years to provide comprehensive security across their systems. Using NetLib’s database encryption technology, Encryptionizer, all information stored on Newport’s cloud-based CARE platform is encrypted so that only authorized parties can access it.
 

 
Click here to read the full article…
 
NetLib Security is the original producer of this publication.
 
 
 
 
 

Revenue Enhancement for FQHCs

Patrick Doyle, Senior Vice President, discusses how Federally Qualified Health Centers can take control of their credentialing life cycle. Federally Qualified Health Centers (FQHCs) are increasingly becoming an integral component of healthcare delivery within the U.S. With greater patient accessibility offered through the Affordable Care Act and Medicaid expansion (in many states), FQHCs deliver critical… Read More

Patrick Doyle, Senior Vice President, discusses how Federally Qualified Health Centers can take control of their credentialing life cycle.

Federally Qualified Health Centers (FQHCs) are increasingly becoming an integral component of healthcare delivery within the U.S. With greater patient accessibility offered through the Affordable Care Act and Medicaid expansion (in many states), FQHCs deliver critical services across the healthcare spectrum to more and more patients every year. Unlike traditional outpatient facilities, these non-profit organizations are tasked with providing complex services regardless of a patient’s ability to pay. Because FQHCs operate with limited budgets, it is essential that every billable dollar is collected. Unfortunately, this doesn’t always happen because of credentialing related denials – the good news is that this problem is preventable.

Costly Credentialing Mistakes

For many reasons, high provider turnover is common in the FQHC space. Given the expanding populations that these facilities serve, and the areas in which they’re located, there is an added urgency to onboard new providers as quickly as possible to ensure that there is no disruption in service. Because the credentialing process can often be a lengthy one, especially in the FQHC environment which requires linking all billable providers to government and commercial plans alike, credentialing, and provider enrollment specifically, is often given a lower priority status within a facility’s revenue cycle. In order to satisfy increasing demand and sustain desired patient through-put, it is not uncommon for FQHC providers to serve their patients with the unfortunate knowledge that they won’t be getting paid.

Given the high mission status of providing their communities with guaranteed healthcare access with very limited financial resources, FQHCs cannot afford to write off an otherwise valid encounter. When they do, the revenue challenges for these facilities become significantly amplified. In addition to hurting their bottom line, FQHCs are also placing a greater burden on those in the community who provide them with financial assistance through charitable contributions as a means to sustain their mission and make up for any revenue shortfalls.

Experienced Staff Helps Recoup Lost Revenue

Like all healthcare providers, there are different situations and levels of credentialing required for FQHCs. Nurse practitioners need to be connected to their payers, participating physicians must be credentialed with all FQHC locations at which they practice, and CAQH attestations need to occur every 120 days (for many payers). Given the complexity of the credentialing and provider enrollment life cycle, relying on manual methods such as manila folders, paper, Excel spreadsheets, and faxing has proven to be an inefficient way to effectively manage these processes. This is especially true for FQHCs with multiple site locations as providers may only be credentialed with some of the locations yet practicing at all of them.

Partnering with an expert credentialing and provider enrollment vendor, like Newport Credentialing Solutions, can significantly reduce the costs of implementing a quality credentialing process while substantially improving revenue by reducing credentialing related denials.

According to a Newport FQHC client, “When credentialing and enrollment are not managed properly, lost revenue is quick to follow. As we learned the hard way, experience matters. Newport’s staff has in-depth knowledge of the credentialing and enrollment processes and has established relationships and good rapport with the payers. This means they know who to call when follow-up is needed which has helped us to recoup significant lost revenue.”

The Newport Difference

A key differentiator when working with Newport is the level of operational and performance visibility that Newport provides. When new providers are on-boarded and need to be credentialed, it can be difficult to track the status of all providers. Newport’s approach to this problem is to offer cloud-based automation and reporting tools which empower facilities to access on-demand information about each provider, location, and payer within their credentialing life cycle. Additionally, Newport’s revenue enhancement tools give facilities a unique ability to measure the at-risk revenue of their outstanding enrollments. Understanding the revenue impact associated with credentialing will help FQHCs make better organizational decisions that foster greater revenue potential.

In the FQHC industry every penny counts. Don’t overlook the importance of having a good credentialing and enrollment process. Take the time to assess where things stand; you may be surprised at just how much money you are leaving on the table – and how much smaller of an investment is required to get it back.

Key Benefits:

• Highly experienced staff
• More efficient, automated processes
• Exceptional tracking and reporting

 

Download

Click here to download the PDF.
 
 

Why Credentialing Should Be on Your New Year’s Resolution List

As seen in Becker’s Hospital Review: Written by Allyson Schiff, VP of Operations for Newport Credentialing Solutions The financial repercussions of expired credentials can be substantial. After all, when providers’ credentials expire, they will not be paid for the procedures they perform. Some plans, such as New York State Medicaid, will go so far as… Read More

As seen in Becker’s Hospital Review: Written by Allyson Schiff, VP of Operations for Newport Credentialing Solutions

The financial repercussions of expired credentials can be substantial. After all, when providers’ credentials expire, they will not be paid for the procedures they perform. Some plans, such as New York State Medicaid, will go so far as to remove a provider from their plan if a license is expired. For a hospital or health system with hundreds, sometimes thousands, of providers, lost revenue resulting from the inability to bill a case can quickly add up.

With the ramifications of expired credentials well known, it is surprising how many hospitals lack an organized, automated way to manage credential expiration dates. To help hospitals regain control over credentialing expirables in the coming New Year, Newport Credentialing Solutions’ Vice President of Operations, Allyson Schiff, shares the following tips…
 
 
As seen in Becker's Hospital ReviewClick here to read the full article…
 
Becker’s Hospital Review is the original producer of this publication.
 
 

Q&A: What is a Par – Non-Par Analysis and Why Is It Important?

Allyson Schiff, Vice President of Operations, discusses the role of the Par – Non-Par Analysis and why it should be a critical part of your credentialing life cycle.   Q. What is a Par – Non-Par Analysis? A. A Par – Non-Par Analysis is the process of validating your provider’s enrollment data with the insurance… Read More

Allyson Schiff, Vice President of Operations, discusses the role of the Par – Non-Par Analysis and why it should be a critical part of your credentialing life cycle.

 
Q. What is a Par – Non-Par Analysis?

A. A Par – Non-Par Analysis is the process of validating your provider’s enrollment data with the insurance plan(s). Known as a Participating and Non-Participating (Par – Non-Par) Analysis, it is the process of validating the participating status of each of your providers across all plans, locations, and Tax IDs. (This can also include specialty and taxonomy code.)

 
Q: Why is a Par – Non-Par Analysis important?

A. A Par – Non-Par Analysis is critically important in that it allows you to create a baseline of who your providers are enrolled accurately with and who they are not. By establishing an enrollment baseline and identifying which providers are NOT enrolled with your plans, you can take pro-active steps to enroll your providers with all of your plans, locations, and Tax IDs.

 
Q: What are some benchmarks that can be followed when conducting a Par – Non-Par Analysis?

A. The basic benchmark to follow when conducting a Par – Non-Par Analysis is: Total Providers * Total Plans * Total Locations. Here is an example:

1. Total Providers – 100
2. Total Plans – 25
3. Total Locations – 10
4. Total Participating Opportunity – 25,000 PINs

 
Q: When conducting a Par – Non-Par Analysis, what is the easiest way to process them?

A. The simplest way is to request rosters from your insurance plan(s). You should ask them for the participating enrollment data that they have for all of your providers, locations, and Tax IDs, specialties and taxonomy codes. When you receive the rosters back, compare the results to your actual providers, locations, and Tax IDs and identify the mismatches. Once the mismatches are identified, initiate enrolling or linking your providers to the missing locations, or Tax IDs.

Another way of conducting a Par – Non-Par Analysis is to contact the payer(s) by telephone. In these instances, you should contact the payer(s) representative, request the current enrollment status of your provider(s) for each location and Tax ID, and compare that to what you believe should be your full enrollment status.

 
Q: How frequently should I conduct a Par – Non-Par Analysis?

A.We recommend conducting a Par – Non-Par Analysis on a quarterly basis.

Conducting a robust Par – Non-Par Analysis is key to ensuing that the enrollment data that you have corresponds to the enrollment data that the payer(s) have. If you do not conduct this analysis, you may be losing revenue and causing patient dissatisfaction.

Download

Click here to download the PDF.

 

Q&A: Leveraging the Cloud to Improve Provider Enrollment Processes

Allyson Schiff, Newport Vice President of Operations, discusses the importance of leveraging the cloud to improve your provider enrollment processes.   Q. How can cloud-based technology help improve the provider enrollment process? A. A successful provider enrollment initiative must be proactive. This means continuous follow-up on outstanding applications and claims. Relying on Excel, Word documents,… Read More

Allyson Schiff, Newport Vice President of Operations, discusses the importance of leveraging the cloud to improve your provider enrollment processes.

 
Q. How can cloud-based technology help improve the provider enrollment process?

A. A successful provider enrollment initiative must be proactive. This means continuous follow-up on outstanding applications and claims.

Relying on Excel, Word documents, or lists to manage this process is simply no longer feasible in today’s highly complex provider enrollment environment.. For midsize organizations, and especially larger organizations with hundreds if not thousands of providers, it is nearly impossible to manage credentialing and enrollment manually. When administrators implement a cloud-based provider enrollment and credentialing solution, the tool will drive the user to become more efficient and enroll their providers faster. Faster enrollment means faster revenue.

 
Q: How does cloud-based technology differ from traditional legacy software?

A. It is not uncommon for legacy credentialing software applications to rely on an outdated technology infrastructure. Known as “client-based servers,” these legacy systems are installed on-site and are not able to provide enterprise-wide access or reporting capabilities. Even with the best people using a client-based server system, makes enterprise-wide data management difficult, if not impossible.

Cloud-based systems provide real-time access to enterprise-wide enrollment data for true multi- location enrollment statistics. Authorized users can access the system by logging into a portal via the Internet. Provider data including names, background information, and copies of documentation are securely stored within these systems for instant access by those who need it in real time. When utilizing a cloud-based enrollment system, your vendor partner (and in-house team) can closely track automated claims on hold and work to pursue a resolution. These systems also offer detailed analytics available with just a few clicks on the keyboard.

 
Q: What other areas within an organization can benefit from access to enrollment information?

A: Utilizing cloud-based technology, organizations can extend access to enrollment information to others within an organization such as patient schedulers. By ensuring that schedulers have real-time, participating status provider enrollment data at their fingertips (whether the provider is participating, non-participating , or is in process of becoming participating at one or many locations), costly and unnecessary claims denials can be avoided. With up-to-date information in hand, if a patient scheduler discovers at the time of scheduling that a provider is not enrolled, the patient scheduler can schedule the patient with a participating provider and therefore avoid a costly claims denial.

 
Q: What if we are outsourcing our provider enrollment process?

A: Whether managing enrollment in-house, or outsourcing with a provider enrollment partner, there are significant benefits associated with cloud-based technology. With the right processes and cloud- based tools in place, lost revenue due to provider enrollment eligibility issues can be significantly reduced, if not eliminated. Having a cloud-based software system in place that allows schedulers to easily view provider enrollment status as patients are being scheduled is essential to achieving long- term financial success.

Download

Click here to download the PDF.

 

5 Ways to Improve Credentialing

As seen in Becker’s Hospital Review: Interview with Scott Friesen, Newport Credentialing’s CEO Credentialing is critical for hospitals and health systems, as it validates a provider’s qualifications, board certifications, work history and references. The term usually comprises two separate processes. One, called privileging, involves approving an individual provider to perform a specific procedure or specific… Read More

As seen in Becker’s Hospital Review: Interview with Scott Friesen, Newport Credentialing’s CEO

Credentialing is critical for hospitals and health systems, as it validates a provider’s qualifications, board certifications, work history and references.

The term usually comprises two separate processes. One, called privileging, involves approving an individual provider to perform a specific procedure or specific set of privileges. The other, provider enrollment, ensures providers are enrolled with all of their organization’s insurance plans, so they receive correct payment.

The credentialing process is a major hurdle for hospitals, ambulatory surgery centers and physician offices. The process can cause significant delays in getting new clinical staff onboard and reimbursed for the services rendered.
 
 
Beckers Hospital ReviewA survey of 500 healthcare industry leaders revealed that… Click here to read the full article.

Becker’s Hospital Review is the original producer of this publication.
 
 
 

Why Credentialing And Provider Enrollment Matter In The Move To Value-Based Care

As seen in Health IT Outcomes: Why Credentialing And Provider Enrollment Matter In The Move To Value-Based Care Written By Scott T. Friesen, Chief Executive Officer, Newport Credentialing Solutions In today’s ever-evolving healthcare environment, many practices are struggling to keep up with rising costs and quality of care demands. With the move from a fee-for-service… Read More

As seen in Health IT Outcomes: Why Credentialing And Provider Enrollment Matter In The Move To Value-Based Care

Written By Scott T. Friesen, Chief Executive Officer, Newport Credentialing Solutions

In today’s ever-evolving healthcare environment, many practices are struggling to keep up with rising costs and quality of care demands. With the move from a fee-for-service payment model to a value-based payment model, these demands have significantly increased.

Health IT OutcomesIn preparation for population health, the number of new hires is expected to be significant as hospitals look to add providers across many specialty areas to help manage the entire continuum of care. The addition of these providers will have a downstream effect on credentialing and enrollment. Organizations that lack the necessary staff and processes to manage provider enrollment can expect… [click here] to read the full article.
 
 
Health IT Outcomes is the original producer of this publication.
 
 
 

Q&A: Is Delegated Credentialing Right For Your Organization?

Allyson Schiff, Vice President of Operations, discusses the role of delegated credentialing and whether it is right for your organization.   Q. What is Delegated Credentialing? A. Delegated Credentialing is the process that insurance payers go through to delegate the Primary Source Verification process to a provider organization in exchange for changing the provider enrollment… Read More

Allyson Schiff, Vice President of Operations, discusses the role of delegated credentialing and whether it is right for your organization.

 
Q. What is Delegated Credentialing?

A. Delegated Credentialing is the process that insurance payers go through to delegate the Primary Source Verification process to a provider organization in exchange for changing the provider enrollment process from a paper based process to a roster based process.

Most payers will only enter into a delegated credentialing contract with provider groups that have greater than 150 providers in their group.

 
Q. What are the primary steps needed to be taken to obtain a Delegated Credentialing Contract?

A. While entering into and successfully running a Delegated Credentialing Contract program is a significant undertaking, the following are a few high level concepts that you will need to consider:

1. Negotiate and enter into a delegated contract with your payer(s). Each contract will need to be individually negotiated and will include the service level agreements / requirements that the provider group and payer(s) need to follow. Fee schedules (if a higher rate is negotiated) will also be included.

2. Build and run (or contract with) a Credentials Verification Organization (CVO) operation within your organization that conducts the Primary Source Verification (PSV) services required by your Delegated Credentialing Contract. While some provider groups have their medical staff services department run their PSV services, there is a growing trend of out-sourcing or conducting the PSV services within the provider enrollment department. The policies and procedures of the CVO will have to be approved in conjunction with the payer(s).

3. Choose the right credentialing software to manage your data and delegated contracts, build your delegated rosters and submit them to your payer(s). Please note, each payer may have a different format pertaining to their delegated credentialing roster.

4. Ensure timely reconciliation of the returned delegated rosters to ensure that the payer(s) have processed all requests correctly.

5. Yearly audits will be performed by the payer(s), and will directly affect the CVO – policies and procedures will be tested to ensure the upkeep of the work is being completed.

 
Q. What are the benefits of Delegated Credentialing?

The benefits are significant. The primary benefit can be the reduction in the time that it takes for a payer to grant the Provider Identification Numbers (PINs) and Effective Dates for membership into the payer’s panels. Other benefits include roster based enrollment (meaning all providers can be added to a single roster and submitted to the payer instead of sending individual applications for each provider), as well as easier tracking and reconciliation processes.

While entering into a Delegated Credentialing Contract program is a significant undertaking, the benefits can significantly improve your organization’s efficiency, patient satisfaction scores, and profitability.

 

Download

Click here to download the PDF.

 

How Does Credentialing Impact RCM? Three Questions with Newport’s CEO Scott Friesen

As seen in Becker’s Hospital Review: Written by Kelly Gooch Scott Friesen, CEO of Lynbrook, N.Y.- based Newport Credentialing Solutions, founded the company in 2009, after spending years in revenue cycle management and finding that provider enrollment with managed care and government insurance plans is becoming increasingly important to RCM. As reimbursement is shifting from… Read More

As seen in Becker’s Hospital Review: Written by Kelly Gooch

Scott Friesen, CEO of Lynbrook, N.Y.- based Newport Credentialing Solutions, founded the company in 2009, after spending years in revenue cycle management and finding that provider enrollment with managed care and government insurance plans is becoming increasingly important to RCM.

As reimbursement is shifting from a fee-for-service to a value-based model, and as hospitals are embracing population health management and risk-based-contracts to meet these new payment requirements, there has been a tremendous aggregation of employed providers in the market, Mr. Friesen says. Therefore, hospitals have had to apply increased resources to make sure all of their newly employed providers are enrolled correctly with their insurance payers.
 
 
As seen in Becker's Hospital ReviewClick here to read the full article.

Becker’s Hospital Review is the original producer of this publication.
 
 

Are You Conducting Pro-Active Quality Assurance on Your Provider Enrollment Applications?

Adriana Evans, Newport Director of Quality and Operations, discusses the importance of conducting pro-active Quality Assurance on your provider enrollment applications.   Q. What is the importance of establishing a pro-active Quality Assurance program within provider enrollment? A. Establishing and maintaining a pro-active Quality Assurance program is key to ensuring that your provider enrollment applications… Read More

Adriana Evans, Newport Director of Quality and Operations, discusses the importance of conducting pro-active Quality Assurance on your provider enrollment applications.

 
Q. What is the importance of establishing a pro-active Quality Assurance program within provider enrollment?

A. Establishing and maintaining a pro-active Quality Assurance program is key to ensuring that your provider enrollment applications will be accepted by the payers on the first submission. The bottom line is that conducting robust Quality Assurance is the difference between your providers being paid by your payers vs. not being paid by your payers.

 
Q. What is the first step in developing a Quality Assurance Team?

A. First, you have to decide that you want to put a Quality Assurance team in place. This team can be comprised of one staff or a number of staff (depending on the size of your department), but the staff need to be 100% dedicated to ensuring that your organization’s quality exceeds industry standards. Depending on the size of your department, consider starting with one Quality Assurance staff member and growing from there.

 
Q. What are some of the areas that a Quality Assurance team should focus on when conducting pro- active Quality Assurance?

A. While there are many, we recommend focusing on two main areas:

1. Provider Demographics – Ensure that all of the provider demographics data elements are accurately entered into your credentialing system as well as mapped to your provider enrollment applications (if paper) or delegated rosters (if delegated).

2. Primary Source Documentation – Ensure that you have collected and added all of the requested primary source documentation to your provider enrollment application (if submitted by paper).

 
Q. How should we conduct our Quality Assurance?

1. Establish a Baseline of Acceptable Quality – Determine a baseline of accuracy. If you have 100 data elements on a paper application, is a 5% error rate acceptable (most likely not, but you get the idea).

2. Establish the frequency upon which you will conduct Quality Assurance. We recommend conducting Quality Assurance daily, but the frequency that you conduct Quality Assurance can be determined based on the availability of your staff.

3. Establish a Quality Assurance Scoring System – A Quality Assurance Scoring system will enable you to quantify an error rate and may serve as a guide toward the frequency in which you conduct your Quality Assurance reviews.

4. Conduct Pro-Active Quality Assurance – While the number of applications to review should be determined by the size of your organization, the following is an example of how you can conduct Quality Assurance.

Quality Assurance should occur in two phases:

a. Initial Quality Assurance Review

b. Subsequent Quality Assurance Reviews

First conduct the initial Quality Assurance Review. This can include the following:

a. Pick 10 provider enrollment applications.

b. Review 100 data elements on each application. If you find that 100 out of 100 of the data elements are entered correctly, move to the next application.

c. If you find 10 or more errors on the application, conduct a full quality assessment on the application. Make sure you document the errors for future reference and re-training.

After you have a baseline of quality from your initial Quality Assurance Review, you can conduct future Quality Assurance reviews based on the scores of the initial Quality Assurance Review. The same process for the Subsequent Quality Assurance Reviews should be conducted as for the Initial Quality Assurance Review.

 
Q. Is Quality Assurance Feedback Important?

A. Absolutely! Giving feedback to your credentialing staff is key to ensuring that the errors do not occur in the future.

a. Review each application and show the Credentialing Specialist what the error was and how to correct it. Provide specific examples to ensure that the Credentialing Specialist understands what was wrong and how to avoid those errors in the future.

b. Ensure that positive and constructive comments are made regarding each account reviewed to assist with providing feedback and development of the Credentialing Specialist.

 
Implementing a pro-active Quality Assurance program will ensure that your applications are being processed by the payers on the first submission, will reduce the Days In Enrollment, and ensure that your providers are being paid timely and efficiently.

 

Download

Click here to download the PDF.
 

Privacy Concerns with Your PECOS Account

Are you concerned about privacy risks associated with granting provider enrollment partners access to your PECOS account? If so, read on…   The Provider Enrollment, Chain and Ownership System (PECOS) is the electronic portal through which physicians enroll in Medicare. While enrolling in PECOS is optional, for now, there are many reasons to utilize PECOS.… Read More

Are you concerned about privacy risks associated with granting provider enrollment partners access to your PECOS account? If so, read on…

 
The Provider Enrollment, Chain and Ownership System (PECOS) is the electronic portal through which physicians enroll in Medicare. While enrolling in PECOS is optional, for now, there are many reasons to utilize PECOS. Unfortunately, miscommunication over privacy concerns are preventing some healthcare organizations from moving forward. With greater education and understanding, the hope is more organizations will take advantage of this valuable tool.

Q. What are the main benefits associated with PECOS?

PECOS makes the move from paper to electronic enrollment a reality. In doing so, costs associated with paper and postage are eliminated. Eliminating “snail mail” also speeds the enrollment process which in turn improves cash flow. If anything is missing from an application, if additional documentation is needed, and/or when the application is complete, Medicare will reach out to the submitter via email. With PECOS, there is no waiting for “snail” mail.

PECOS offers a real-time view of provider enrollment status. Without PECOS, this information could only be retrieved by calling Medicare and speaking with them directly. If the person inquiring about a provider’s enrollment status is not listed on the provider’s profile, Medicare will not give any status on the pending enrollment. With access to PECOS, anyone listed as a contact on the provider’s individual record can easily pull enrollment status details.

 
Q. My organization utilizes an outsourced provider enrollment company, is there any benefit to allowing them to access PECOS?

With access to PECOS, a partner company can efficiently manage the entire initial and re-validation process. The burden of completing Medicare enrollments can be greatly alleviated when allowing the enrollment partner to act on the provider’s behalf. For larger organizations with hundreds of providers, outsourcing Medicare enrollment to a partner is a tremendous time and financial saver.

An enrollment partner can act on a provider’s behalf after being granted Surrogacy Access. Surrogacy access allows designated staff at the enrollment partner company to log into a provider’s portal to complete and manage the provider’s Medicare enrollment.

 
Q. Are there privacy risks when allowing a partner company to access a provider’s PECOS account?

For those who want tighter control, PECOS offers the option of logging in and authorizing someone to work on the provider’s behalf. The authorized person then creates his/her own user name and password.

Bottom line: Provider enrollment professionals know what they are doing and will work to make sure the provider gets paid appropriately. Enabling them to access PECOS will allow them to do their job more efficiently and to get your provider’s billing faster than if processed via paper.

 

Download

Click here to download the PDF.
 

Q&A: Is Your Provider Enrollment Software Keeping Up With the Rapidly Evolving Credentialing Landscape?

David Meier, Newport VP of Technology Solutions, discusses ways to ensure that your provider enrollment software is meeting all of your operational and reporting requirements.   Q. How do you identify if your provider enrollment software is keeping up with the changing times? A. One area to look at is workflow software. A couple of… Read More

David Meier, Newport VP of Technology Solutions, discusses ways to ensure that your provider enrollment software is meeting all of your operational and reporting requirements.

 
Q. How do you identify if your provider enrollment software is keeping up with the changing times?

A. One area to look at is workflow software. A couple of questions to ask include:

1. Does your provider enrollment software enable you to manage your provider’s credentialing life cycle using workflow tools that make the enrollment process easier, rather than more difficult?

2. Do your software have advanced workflow and reminder systems that stratify your activities based on gross charges linked to your “in-process” applications?

3. Does your software keep track of all follow up notes in an easy to document and report on module?

4. Is your reporting tool easy to use? Do you have click, drag, and drop reporting?

Another area to look at is productivity. Using your current provider enrollment software, are you able to ensure that your staff are staying on top of their daily tasks in an easy to track and trend manner? Further, are you able to easily report on your staff’s productivity to ensure that they are taking the correct actions and in the appropriate time?

 
Q. What is the impact of having a provider enrollment software tool that is agile enough to meet the changing provider enrollment requirements?

A. There are many benefits that come from having an agile provider enrollment software, but here are three:

1. Increased Revenue – When your software can link gross charges to your “in-process” applications, you can stratify your activities to ensure that you are working those providers with the highest number of charges first, and then work those providers with a lower amount of charges second.

2. Increased Productivity – When your software enables you to work your provider’s credentialing life cycle by “task” (meaning data entry, application processing, follow up, and PIN entry), you gain increased productivity (meaning specialization of task) and increased staff stability (meaning you can more easily hire staff who specialize in data entry than understand the entire credentialing life cycle).

3. Increased Performance Through Reporting – When your software enables you to easily track and report on each step of the credentialing life cycle, you are able to establish performance baselines from which you can improve overall performance.

 

Download

Click here to download the PDF.
 

Q&A: 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.

 

Download

Click here to download the PDF.
 

Q&A: Is Your Provider Enrollment Department As Productive As It Should Be?

Anitra Montgomery, Newport Director of Operations, asks if your providers are as productive as they should be and offers ways to improve their productivity. Q. How do you identify provider enrollment productivity measures? A. One area to look at is productivity across the entire credentialing life cycle. What are the main tasks of your organization’s… Read More

Anitra Montgomery, Newport Director of Operations, asks if your providers are as productive as they should be and offers ways to improve their productivity.

Q. How do you identify provider enrollment productivity measures?

A. One area to look at is productivity across the entire credentialing life cycle. What are the main tasks of your organization’s credentialing life cycle and how do you track them? Some key tasks include:

1. Data Entry – How long does it take to enter a provider into your provider enrollment software, into CAQH, and into PECOS?

2. Application Processing – How long does it take to print out an application and send it to your provider for signature?

3. Provider Turn Around – How long does it take for your provider to sign his/her application(s)?

4. Send Application to the Payer – Once the signature packets have been received by your staff, how long does it take to send the completed application(s) to the payer?

5. Follow up Activity – Are your staff taking the correct actions to ensure that they are quickly obtaining your provider’s Provider Identification Numbers (PINs)?

You want to ensure that your staff are staying on top of their daily tasks in an easy to track, trend, and report on manner.

 
Q. How do you track, trend, and report on your staff’s productivity?

A. It is critical that you are able to report on the activities that you staff are taking. Cutting edge provider enrollment tools will allow you to track, trend, and report on the activities that your staff are taking.

 
Q. How do you track, trend, and report on your staff’s quality?

A. It is also critical that you are able to report on the quality of the actions that your staff are taking. As with productivity reporting, you need to be able to report on the quality of the work that your staff is doing. Additionally, you need to be able to provide quality assurance feedback to your staff based on the quality measures that you have tracked.

Ensuring that you have a standard set of productivity measures across the entire credentialing life cycle and are able to track and report on those measures is the first and most critical step toward improving your staff’s productivity.

 

Download

Click here to download the PDF.
 

Q&A: The Benefits of Implementing Provider Enrollment Metrics

Patrick Doyle, Newport VP of Business Development, shares the benefits of implementing provider enrollment metrics for your Provider Enrollment Department. Q. What are some of the common areas where high-performing hospitals and health system can improve? A. One area where hospitals and health systems can improve is by focusing on their Provider Enrollment Departments. Hospitals… Read More

Patrick Doyle, Newport VP of Business Development, shares the benefits of implementing provider enrollment metrics for your Provider Enrollment Department.

Q. What are some of the common areas where high-performing hospitals and health system can improve?

A. One area where hospitals and health systems can improve is by focusing on their Provider Enrollment Departments. Hospitals and health systems are spending so much of their time preparing for payment reform and population health management, that they often overlook the importance of their Provider Enrollment Departments and how those departments will help them execute their population health management strategies.

 
Q. What are some particular areas that that providers and administrators can focus on?

A. Provider Enrollment Metrics. Despite being a critical part of any revenue cycle, there are very few industry wide metrics that are followed.

 
Q. What is the impact of not following the right provider enrollment metrics?

A. Lost revenue. If your providers are not fully enrolled with all of their locations and payers, and you do not have the metrics to track their enrollments, your providers will not be paid correctly and you won’t know it.

 
Q. What are some examples of provider enrollment metrics that can be used?

A. One example would be understanding your “Participating,” “Non-Participating,” “In-Process,” and “Total Opportunity?” In order to best understand these metrics, you have to understand how many providers, payers, and locations that you want your providers to participate with. The goal is to be as close to 100% as possible.

In order to calculate your “Par Percentage,” you can use the following formula: Total Providers * Total Number of Locations * Total Number of Payers. Therefore, if you have 10 providers, and 10 locations, and 10 plans, your total “Participating Opportunity” is 1,000. If you are only 80% “Participating” that means you are “Not Participating” in 20% of your plans or locations. Your Non-Participating status means that your claims are being denied and you are risking lost revenue.

Another metric to track is your Days In Enrollment (DIE) for your delegated and non-delegated payers. The DIE tracks your department and your payer’s performance. The formula for calculating DIE is: Total number of elapsed days from the time your submit a paper application to a payer, compared to a standard turn around time (e.g., 90 days). If the total number of elapsed days is 120, you know the payer is not performing well. If the total number of elapsed days is 45, you know the payer is performing better than the average.

 
Q. What are the steps involved in developing these provider enrollment metrics?

A. Understand that provider enrollment is no different than other aspects of your revenue cycle. A helpful step is for hospitals and health systems to identify those credentialing metrics that are important to your organization and revenue, and implement the correct tools and benchmarks you want to measure your performance against. Another step is to compare your performance to your industry peers.

 

Download

Click Here to download the PDF.

Q&A: Are You Using the Cloud To Improve Your Provider Enrollment Operations?

David Meier, Newport VP of Technology Solutions, discusses the increasing importance of using the cloud to manage your Provider Enrollment. Q. The cloud is becoming increasingly important in healthcare. What are some of the things to consider when looking to move your healthcare data to the cloud? A. As more and more of US healthcare… Read More

David Meier, Newport VP of Technology Solutions, discusses the increasing importance of using the cloud to manage your Provider Enrollment.

Q. The cloud is becoming increasingly important in healthcare. What are some of the things to consider when looking to move your healthcare data to the cloud?

A. As more and more of US healthcare providers move their data to the cloud, its important to understand some key reasons for doing so. 3 key reasons include:

1. Increased Data Security – Leading cloud providers host their client’s data with HIPAA and HITECH compliant data centers such as Amazon Web Services (AWS). Provider data is housed in centralized and protected data centers and is monitored by physical security guards that use leading physical (such retinal and fingerprint scans to get into the data center) and data security measures (such as advanced firewalls, intrusion detection systems, and data encryption software).

2. Lower Expense – Cloud providers enable provider enrollment departments to implement leading hosting and security technology without the upfront cost of installing, implementing, and maintaining expensive servers and data encryption software.

3. Scalability – Cloud providers can easily scale to meet your provider enrollment department’s data and storage requirements. Increased data capacity can be easily obtained through a quick discussion with your cloud provider.

 
Q. What are some of the questions to ask your cloud provider in considering moving to the cloud?

A. It’s important to fully understand with who, how, and where your cloud provider stores your data. Ask your cloud provider the following questions:

1. How is my data backed up? Ask how your cloud provider backs up or “replicates” your data. Do they have “redundant back ups” (meaning do they have two or more servers to back up your data in the event that one fails).

2. Is my data encrypted? Ask whether your data is encrypted both “in transit” (meaning as it goes from the data center to your healthcare institution), as well as “at rest” (meaning while it is physically resting in the data warehouse).

3. Where is my data physically stored? Ask if your cloud provider’s data is stored “on-shore” or “off-shore.” Often, provider enrollment departments and healthcare institutions request that their data is stored within the United States.

4. Does my cloud provider follow HIPAA and HITECH compliant security measures?

Asking the following questions will ensure that your cloud provider is securing your data in the best manner possible and is doing so at a cost to you that is cheaper than you can manage in-house.

 

Download

Click here to download the PDF.
 

Q&A: The Importance of Utilizing Key Performance Indicators (KPIs) In Provider Enrollment

Allyson Schiff, Newport VP of Operations, discusses the importance of utilizing robust Key Performance Indicators (KPIs) to improve your provider enrollment department’s performance. Q. How do you identify which KPIs you should be using? A. The first thing you should do is understand what are the key tasks in your Department of Provider Enrollment that… Read More

Allyson Schiff, Newport VP of Operations, discusses the importance of utilizing robust Key Performance Indicators (KPIs) to improve your provider enrollment department’s performance.

Q. How do you identify which KPIs you should be using?

A. The first thing you should do is understand what are the key tasks in your Department of Provider Enrollment that you want to track, trend, and report on. Some examples include:

1. Days In Enrollment (DIE) – The DIE tracks your department and payer’s performance. The formula for calculating DIE is: Total number of elapsed days from the time your submit a paper application to a payer, compared to a standard turn around time (e.g., 90 days). If the total number of elapsed days is 120, you know the payer is not performing well. If the total number of elapsed days is 45, you know the payer is performing better than the average.

2. Department Processing Times – How long does it take your staff to data enter a provider into their credentialing system, CAQH and PECOS?

3. Provider Processing Times – How long does it take for your providers to sign their signature pages and get them back to your department?

4. In-Process Charges – What are the total number of gross charges that are associated with your in-process applications? Can you break this down by health system, hospital, clinic, provider, payer?

5. Quality – What quality metrics are your staff supposed to take when updating their payer follow up notes? Are they documenting who and when they spoke with a payer representative or what is the next action step that they need to take to obtain the PIN?

 
Q. Once you identify the KPIs you want to track, how do you begin to track them?

A. The easiest way is through technology. Check to see if your provider enrollment software will allow you to track specific KPIs. If your provider enrollment software does not allow you to track these KPIs, begin to track them manually, or via excel. The key is to track them so that you can establish performance baselines and then improve upon those metrics.

Identifying KPIs are a critical component to improving your department’s performance.

 

Download

Click here to download the PDF.
 

Credentialing Challenges and Opportunities for Independent Physicians

Patrick Doyle, Newport VP of Business Development shares the credentialing challenges and opportunities of Independent Physicians and the newly formed state and federal exchange plans Q. How does the addition of new state and federal exchange plans challenge your practice? A. The addition of new federal and state exchange plans creates a distinct credentialing challenge… Read More

Patrick Doyle, Newport VP of Business Development shares the credentialing challenges and opportunities of Independent Physicians and the newly formed state and federal exchange plans

Q. How does the addition of new state and federal exchange plans challenge your practice?

A. The addition of new federal and state exchange plans creates a distinct credentialing challenge in that it causes independent physicians to constantly stay on top of which plans are their patients joining. Further, independent physicians need to balance the increased patient volume and the corresponding revenue generated from those patients, to the time and cost involved in enrolling themselves with the new exchange plans. If they deem the patient volume and revenue to be significant, it is in their best interest to enroll with those plans as soon as possible.

Q. How does an independent physician identify new state and federal exchange plans?

A. Independent physicians should pay close attention to the types of insurance that their patients have. Often, the physician’s electronic health record (EHR) and practice management system (PM) will allow the physician to run reports so that they can quantify all of their accepted insurances and the revenue tied to each insurance. It is at that point that the physician can identify the new exchange plan and initiate enrollment.

Q. What risks exist to the provider if they don’t stay on top of the new exchange plans?

A. Lost revenue. If a physician is not enrolled with their patient’s exchange plans, the physician risks not being paid for rendered services. It is important to recognize that not having an effective physician credentialing strategy can result in a significant reduction in revenue.

Implementing a comprehensive physician credentialing strategy, whether in-house or with an outsourced credentialing partner, ensures that the physician will be paid timely and correctly.

Download

Click here to download the PDF.

Credentialing Challenges and Opportunities for Physician Practices

Patrick Doyle, Newport VP of Business Development shares the credentialing challenges and opportunities of Physician Practices and the newly formed state and federal exchange plans. Q. How does the addition of new state and federal exchange plans challenge your practice? A. The addition of new federal and state exchange plans creates a distinct credentialing challenge… Read More

Patrick Doyle, Newport VP of Business Development shares the credentialing challenges and opportunities of Physician Practices and the newly formed state and federal exchange plans.

Q. How does the addition of new state and federal exchange plans challenge your practice?

A. The addition of new federal and state exchange plans creates a distinct credentialing challenge in that it causes physician practices to constantly stay on top of which plans are their patients joining. Further, physician practices need to balance the increased patient volume and the corresponding revenue generated from those patients, to the time and cost involved in enrolling themselves with the new exchange plans. If they deem the patient volume and revenue to be significant, it is in their best interest to enroll with those plans as soon as possible.

Q. How does an independent physician identify new state and federal exchange plans?

A. Physician Practices should pay close attention to the types of insurance that their patients have. Often, the physician’s electronic health record (EHR) and practice management system (PM) will allow the physician to run reports so that they can quantify all of their accepted insurances and the revenue tied to each insurance. It is at that point that the physician can identify the new exchange plan and initiate enrollment.

Q. What risks exist to the provider if they don’t stay on top of the new exchange plans?

A. Lost revenue. If a physician is not enrolled with their patient’s exchange plans, the physician risks not being paid for rendered services. It is important to recognize that not having an effective physician credentialing strategy can result in a significant reduction in revenue.

Implementing a comprehensive physician credentialing strategy, whether in-house or with an outsourced credentialing partner, ensures that the physician will be paid timely and correctly.

Download

Click here to download the PDF.

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.

Download

Click here to download the PDF.

Logo Header Menu