Thought Leadership

New Perspectives To Improve the Credentialing Industry

Category: Physician Credentialing

3 Tips to Avoid Post-M&A Revenue Disruptions

As seen in Becker’s Hospital CFO Report: Written by Scott Friesen, CEO of Newport Credentialing Solutions Healthcare merger and acquisition (M&A) activity is at an all-time high. For hospitals and health systems looking for new ways to stay competitive and expand their offerings, mergers and acquisitions have become a viable option. While healthcare organizations have… Read More

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

Healthcare merger and acquisition (M&A) activity is at an all-time high. For hospitals and health systems looking for new ways to stay competitive and expand their offerings, mergers and acquisitions have become a viable option.

While healthcare organizations have gotten better at post-M&A integration throughout the years, it is not uncommon for revenue disruptions to occur because of an oversight. One common area that is often overlooked is provider data management (PDM). When provider contracting and data management are not factored into M&A integration plans, hospitals and health systems put themselves in a costly financial position.

To avoid post-M&A revenue disruptions associated with provider data management integration issues (this includes credentialing and provider enrollment), consider the following…

 
 

Click here to finish reading the full article…
 
Becker’s Hospital CFO Report is the original producer of this publication.
 
 

Doctors Without Dashboards

As seen in Exago: Written by Nicole Hitner Things change slowly in the healthcare industry, but according to Newport Credentialing VP Technology David Meier, they are changing—and for the better. Before the Affordable Healthcare Act (ACA) became law in 2010, patients, care provider groups, and insurance companies were in a three-way tug of war over… Read More

As seen in Exago: Written by Nicole Hitner

Things change slowly in the healthcare industry, but according to Newport Credentialing VP Technology David Meier, they are changing—and for the better.

Before the Affordable Healthcare Act (ACA) became law in 2010, patients, care provider groups, and insurance companies were in a three-way tug of war over finances, each party trying to get the highest return on its investment. Although the country’s quest for an optimized healthcare system continues, Meier says the tone of the conversation has moved away from competition and toward patient-centered systems such as value-based care, a more holistic alternative to fee-for-service payment models.

“There has been a major shift in the industry as a whole,” says Meier. “Before, these three groups had their own agendas and didn’t really work well together. Now, provider organizations are working to align with patients’ needs in order to keep them healthy and happy.”

This paradigm shift has had a major impact on healthcare information systems. Now, more than ever, federal regulators are enforcing data integrity standards and holding providers and insurers accountable for their records, putting companies like Newport Credentialing at the center of the action.

Newport Credentialing Solutions produces CARE, a cloud-based credentialing and provider enrollment application complete with workflows, analytics, and business intelligence. Medical groups use CARE to manage their relationships with insurers like MVP and UnitedHealth. Because the providers, or doctors, in each group must enroll with each insurer separately, the recordkeeping is extensive. Not only that, but each insurer has its own requirements for when and how often providers need to update their information, as governmental penalties for inaccuracy are passed down through the insurer to the doctors themselves.

“It’s really become more and more important that the data that we’re providing to the health insurance plans is accurate,” says Meier. “And this is where business intelligence really fits into the whole thing.”

According to Meier, modern solutions like CARE find themselves thrust into an ecosystem of disjointed technologies. Although provider groups are continuing to consolidate into larger medical groups, their backend processes and programs are failing to keep pace. As a result, providers often have no way to visualize or even query their data themselves.

In these conditions, even running simple reports is an ordeal. “Let’s say a medical group wants to see all their providers and the locations where those providers are seeing patients,” Meier offers by way of example. “Usually what happens is they have to put in a request to IT, IT has to go into an approval process that then gets slated for work, and then it takes two or three weeks for them to start working on the order. Maybe it’s eight hours worth of effort. The group needs something tomorrow, but they’re not going to get it for a month and a half. And that’s not exaggerating.”

When Newport comes on the scene, its business intelligence capabilities change all this for the client organization. Where before providers were relying on spreadsheets and black boxes, now they are able to access, visualize, and report on their data. Some even elect to use CARE’s ad hoc reporting tool to build custom reports on the fly.

As exciting as this newfound freedom is for provider groups, Meier sees BI’s impact on data management as even more significant. CARE connects to a variety of platforms including billing, HR, privileging, and central verification office systems. In many cases, these systems do not interface with each other, and their manually-entered data is rife with inconsistencies. As the reporting hub and common link between these disjointed systems, CARE often becomes the “source of truth” for provider groups, writing cleansed data to the other systems in the network.

“Although provider data management hasn’t historically been a central tenet of provider enrollment, we realized early on that it needed to be,” Meier explains. “Organizations need to centralize this data somewhere. It can’t be in a hundred different systems throughout the organization, and you can’t filter on a location if you have fifty different ways of spelling it.” BI by its very nature is compelling healthcare organizations to clean up their data practices.

But BI is also helping Newport speed up some of the bureaucratic processes that have been holding healthcare back in the first place. With hard data their fingertips, CARE agents are able to tell medical groups how long it takes them to, for example, complete a step of the enrollment process and flag possible inefficiencies. “It was taking around 45 days for one of our clients to get information back to us,” relates Meier. “We showed them this because we have the data and, in doing so, we cut that down to about 12 days.”

For Meier and the rest of the Newport team, these kinds of victories are ultimately about providing better care. If healthcare 1.0 was about profit, then healthcare 2.0 is, as Meier puts it, about “prioritizing patient health.”

“There are downstream effects for everybody,” he says. “For us, it’s managing data and making sure that provider data is as accurate as possible.”

Exago is the original producer of this publication.

RCM Tip of the Day: Include Provider Data Management in M&A Integration Plans

As seen in Becker’s Hospital CFO Report: Written by Kelly Gooch Hospitals involved in mergers and acquisitions shouldn’t forget to include provider data management to ensure claims payment, according to Scott Friesen, CEO of Newport Credentialing Solutions. “When a big acquisition or merger occurs, plans must be put into place to accelerate the provider onboarding/integration… Read More

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

Hospitals involved in mergers and acquisitions shouldn’t forget to include provider data management to ensure claims payment, according to Scott Friesen, CEO of Newport Credentialing Solutions.

“When a big acquisition or merger occurs, plans must be put into place to accelerate the provider onboarding/integration process. Tax identification numbers, lockbox services, and provider data must be integrated along with the ability to link providers from ‘hospital A’ to contracts with the insurance companies at ‘hospital B,” Mr. Friesen shared with Becker’s Hospital Review. “Strategic decisions must be made on how to best manage provider data.

Click here to read the full article…

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

How Silos Restrict Key Information Sharing Within Hospitals

As seen in Health Data Management: Written by Scott Friesen The healthcare industry is undergoing a massive change as it transitions toward a connected network of clinical and administrative services, with the goal of improving patient quality and clinical outcomes. However, as demonstrated through electronic health record systems utilization, an interconnected network can be a… Read More

As seen in Health Data Management: Written by Scott Friesen

The healthcare industry is undergoing a massive change as it transitions toward a connected network of clinical and administrative services, with the goal of improving patient quality and clinical outcomes. However, as demonstrated through electronic health record systems utilization, an interconnected network can be a complex endeavor.

The rush to deploy EHR systems was driven largely by the Centers for Medicare and Medicaid’s Meaningful Use federal incentive program. Huge financial incentives helped speed the transition from paper to digital records. While great strides have been made in this transition, a new light has been cast on EHRs and the significant interoperability challenges that continue to exist.

Technology is rapidly advancing, and vendors have learned a lot from EHR deployments. Arguably, the biggest lesson is to address the continued need to easily share data between disparate systems. After all, no matter how much data is captured within a system, its value is greatly diminished when it can’t be shared with other systems, groups and organizations. When left in their separate data silos, resources, outcomes, revenue and other areas are negatively impacted.
 
 
Click here to finish reading the full article…
 
Health Data Management is the original producer of this publication.
 
 

Newport Credentialing Solutions Ranks No. 1 Among Credentialing and Privileging Firms in Black Book Survey

Newport Credentialing Solutions, a division of TractManager, Inc., is the top-ranked provider of credentialing and privileging solutions in a second-quarter 2018 outsourcing user survey conducted by Black Book Market Research, an independent market research company. Black Book reports that more than 4,500 executives, hospital board members, and senior managers from 709 hospitals took part in… Read More

Newport Credentialing Solutions, a division of TractManager, Inc., is the top-ranked provider of credentialing and privileging solutions in a second-quarter 2018 outsourcing user survey conducted by Black Book Market Research, an independent market research company. Black Book reports that more than 4,500 executives, hospital board members, and senior managers from 709 hospitals took part in the survey, which rated vendors from 16 categories of outsourced services.

Click here to read the full article…

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.
 
 

Newport Credentialing Recognized by CIOReview Magazine as 50 Most Promising Healthcare Solution Providers – 2018

An annual listing of the best vendors who provide exceptional solutions to enhance the entire healthcare experience for both providers and patients. As the healthcare industry continues to evolve, an increasing number of healthcare organizations are moving from client-server environments to cloud-based environments. Yet a significant portion of the industry continues to remain tethered to… Read More

An annual listing of the best vendors who provide exceptional solutions to enhance the entire healthcare experience for both providers and patients.

As the healthcare industry continues to evolve, an increasing number of healthcare organizations are moving from client-server environments to cloud-based environments. Yet a significant portion of the industry continues to remain tethered to client-server environments which create unnecessary data silos and cause significant data integrity issues. On the provider data management front, there are limited cloud platforms that offer a single database and multi-channel architecture capable of running broad analytics across a huge spectrum of data. Data consolidation is also problem. Even if several credentialing and enrollment tools are used, they only cater to one data source at a time. Newport Credentialing Solutions was created to break down these credentialing data silos and streamline the flow of data across multiple data systems.

Newport is transforming the credentialing technology space with its cloud-based provider credentialing and enrollment software by enhancing the provider data management lifecycle and breaking down data barriers between hospitals, providers, and payers. Newport also helps with data cleansing which provides security to patients while increasing revenue generation for providers.

“At Newport, we want to break the silos, reduce cost, and increase revenue for clients while enhancing clinical outcomes and patient satisfaction,” states Scott Friesen, CEO, Newport. Newport’s cloud-based enrollment credential software features 20 different modules which help clients manage the credentialing lifecycle from data entry to full enrollment and connects gross financial charges to all in-process enrollment applications. Newport also provides cloud-enabled support services with staff to assist healthcare systems in managing credentialing process. Clients using Newport’s cloud-based credentialing and provider enrollment enterprise-wide platform have the option to outsource the credentialing and provider enrollment process to Newport or license Newport’s technology to conduct the credentialing and enrollment process themselves.

To improve data integrity, Newport provides their clients with portals which help them refer back to clients in the event information provided is inaccurate. Newport embeds their technology into the daily workflow of hospitals, health systems, and medical group clients for easy data entry, lookup and validation. Friesen explains that the company’s cloud-enabled CARE suite of products inculcates the concept of revenue and credentialing into their client’s daily processes through the use of a singular platform. The CAREportal tool, an online information exchange solution, allows clients to request any change, add, or delete regarding their provider’s profile directly into the platform’s multi-tenant platform. Newport uses third-party encryption tools to ensure data security and customizes their technology to mimic the organizational structure of clients to best serve their interest. Additionally, Newport spends an extensive amount of time validating data with insurance companies to reduce the data cleansing workload of its clients.

Friesen shares a case wherein Cooper University Healthcare was losing millions of dollars on enrollment denials. With Newport’s bundled provider enrollment software and services, the healthcare system was able to reduce 90 percent of denials within 18-24 months of the product’s implementation. Newport launched their technology, on-boarded the client, and conducted a PAR/non-PAR analysis to validate their baseline for enrollment. Newport’s reporting and analytics tool also helped the client understand challenges related to real-time information gathering and enabled gross charges to be linked to in-progress applications for tracking performance on a day-to-day basis. As a result, the client was able to collect $1.5 million incremental revenue during the first year of implementation.

Healthcare reforms have created numerous opportunities to improve provider data management. Newport has built a robust roadmap to take advantage of these opportunities and to manage data processing in a far more cost-effective and efficient manner. “As one of the largest providers of enrollment software and services we manage about 45,000 providers. But of the 1.2 million enrollable providers in the U.S., it is only a drop in the bucket,” states Friesen. Therefore, for 2018, Newport’s main focus is on expanding its cloud-based provider data management and credentialing footprint to create a more accurate and streamlined provider data management landscape.

To learn more, please click here.

2018 January Newsletter: In Case You Missed It

Newport Credentialing: In Case You Missed It For Newport, the past two months have been very busy and exciting preparing for 2018! Below are a few highlights of our successes we wanted to make sure you didn’t miss.   Newport Credentialing Unveils New Website Design We have been hard at work enhancing our website to… Read More

Newport Credentialing: In Case You Missed It

For Newport, the past two months have been very busy and exciting preparing for 2018! Below are a few highlights of our successes we wanted to make sure you didn’t miss.
 

Newport Credentialing Unveils New Website Design

We have been hard at work enhancing our website to give users an even better experience. We encourage you to stop by and take a look for yourself. Visit the website or read the full press release.
Read the press release here.
 
 

Hosted a Webinar on how to “Exceed Your 2018 Revenue Goals”

In December, Newport hosted a 30-minute webinar with tips and trick on how to Exceed Your 2018 Revenue Goals by improving the credentialing & enrollment process.
REQUEST ON-DEMAND WEBINAR.
 
 

Follow us on Facebook, Twitter, and LinkedIn!

Join the Newport community on social media in order to stay on top of all news related to credentialing, enrollment, and provider data management. We would love to connect with you!
Facebook | Twitter | LinkedIn
 
 

Come Find Newport at AMGA!

This March we will be exhibiting at the Annual AMGA Conference in Phoenix, AZ. Be sure to stop by our booth or schedule a meeting with us in advance so we don’t miss each other! The conference will be held from March 7-10th.
Schedule a meeting.
 
 

Newport Celebrated the Holidays in Style

The Newport Credentialing staff celebrated the holiday season in style with an Ugly Sweater Party. Thank you to all of our staff for a wonderful turnout and for all of your hard work and dedication throughout the year!

160+ Healthcare Revenue Cycle Companies to Know

As seen in Becker’s Hospital Review: Written by Laura Dyrda
Hospitals, health systems, physician practices and healthcare organizations are experiencing increasingly complex revenue cycles, working with government and private payers as well as patients to collect. Here are more than 160 companies with revenue cycle management solutions in the healthcare space… Read More

As seen in Becker’s Hospital Review: Written by Laura Dyrda

Hospitals, health systems, physician practices and healthcare organizations are experiencing increasingly complex revenue cycles, working with government and private payers as well as patients to collect. Here are more than 160 companies with revenue cycle management solutions in the healthcare space.
 
 
As seen in Becker's Hospital ReviewClick here to read the full article…
 
Becker’s Hospital Review is the original producer of this publication.
 
 

2017 September Newsletter: In Case You Missed It

Newport Credentialing: In Case You Missed It For Newport, the past two months have been very busy and exciting preparing for fall! We were featured in several articles, partnered with new healthcare organizations, continued our webinar series, and much more. Below are a few additional highlights of our successes.   Featured in Becker’s Hospital Review:… Read More

Newport Credentialing: In Case You Missed It

For Newport, the past two months have been very busy and exciting preparing for fall! We were featured in several articles, partnered with new healthcare organizations, continued our webinar series, and much more. Below are a few additional highlights of our successes.
 

Featured in Becker’s Hospital Review: Key Considerations When Selecting a Credentialing Company

Outsourcing your credentialing and enrollment process is a much easier and cost-effective option compared to managing the process in-house. In this article, find out what to consider when selecting a partner.
Read the full article here.
 
 

Featured in Becker’s Hospital CFO Report: RCM Tip of the Day

Are you underestimating the importance of participating and nonparticipating analysis? Click here to read Becker’s RCM Tip of The Day featuring Newport Credentialing!
Read the full article here.
 
 

Lina Monterosso Shares her Experience Working with Newport

Lina Monterosso, former VP Revenue Management at FOX Rehabilitation, has first-hand experience partnering with Newport Credentialing. See what she has to say about her experience.
Read the full article here.
 
 

Hosted a Webinar for Federally Qualified Health Centers


In August, Newport hosted a 30-minute webinar for FQHCs helping educate them on how to improve their provider enrollment process with just five actionable tips.
To receive a copy of the presentation, please send us an email.
 
 

Join our Growing Team!

Newport is hiring Credentialing Specialists, Account Supervisors, and Data Entry Specialists. To apply, please submit a copy of your resume to careers@newport.theadleaf.com. For more information about the jobs available, visit our Careers page.

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.

See What Our Clients Are Saying: Atlanticare

Tony Cottone, former Director of Revenue Cycle at AtlantiCare, implemented our credentialing and provider enrollment services at APG, vastly improving processes and increasing revenue. See what he has to say about his experience… Read More

Tony Cottone Former Director of Revenue Cycle; Consultant Atlanticare Physician Group

Tony Cottone, former Director of Revenue Cycle at AtlantiCare, implemented our credentialing and provider enrollment services at APG, vastly improving processes and increasing revenue. See what he has to say about his experience.

 
 

See What Our Clients Are Saying: FOX Rehab

Lina Monterosso, VP Revenue Management at FOX Rehabilitation, has first-hand experience partnering with Newport Credentialing. See what she has to say!… Read More

Lina Monterosso: VP Revenue Management Fox Rehabilitation

Lina Monterosso, VP Revenue Management at FOX Rehabilitation, has first-hand experience partnering with Newport Credentialing. See what she has to say!.

 
 

For Organizational Guidance – A Compass or a GPS?

As seen in Becker’s Health IT & CIO Review: Written by Scott Friesen, CEO, and Patrick Doyle, Senior Vice President, Newport Credentialing Solutions Managing the revenue cycle for healthcare organizations is a complex endeavor. To navigate the many variables associated with successful reimbursement, revenue cycle management is becoming increasingly reliant on data analytics. Understanding which… Read More

As seen in Becker’s Health IT & CIO Review: Written by Scott Friesen, CEO, and Patrick Doyle, Senior Vice President, Newport Credentialing Solutions

Managing the revenue cycle for healthcare organizations is a complex endeavor.

To navigate the many variables associated with successful reimbursement, revenue cycle management is becoming increasingly reliant on data analytics. Understanding which data points to focus on is key to obtaining operational and financial excellence. Just like using a GPS navigation tool is more precise and easier to use than a hand-held compass, managing the complex revenue cycle requires the same kind of advanced tool-set that can normalize and present data in a precise and easy to use manner.

While there are many moving parts in the healthcare revenue cycle, a frequently overlooked component is…
 
 
As seen in Becker's Health IT & ReviewClick here to read the full article.

Becker’s Health IT & CIO Review 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.

 
 

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.
 
 

The Invisible Impact of Credentialing: Tip 2

Tip 2: Make Sure All Data is Protected – Not Just PHI.   More than two decades ago, the Health Insurance Portability and Accountability Act (HIPAA) was signed into law. One of its most significant provisions was to create a standard method of protecting patient data, regardless of where it resides. In 2000 additional safeguards… Read More

Tip 2: Make Sure All Data is Protected – Not Just PHI.

 
More than two decades ago, the Health Insurance Portability and Accountability Act (HIPAA) was signed into law. One of its most significant provisions was to create a standard method of protecting patient data, regardless of where it resides. In 2000 additional safeguards were put in place and Protected Health Information (PHI) became the responsibility of everyone in the healthcare sector. As a result…

[click here to download].
 
 

Looking for additional tips?

To download Tip 1, please click here.
 
 

The Invisible Impact of Credentialing: Tip 1

Tip 1: Credentialing Can Disrupt Your Patient Satisfaction Outcomes.   With the advent of Accountable Care Organizations (ACOs) and population health management initiatives, healthcare organizations are increasingly implementing technology and processes to encourage patient engagement. Incumbent in these efforts is the collection of more patient satisfaction data to help yield better decision making to promote… Read More

Tip 1: Credentialing Can Disrupt Your Patient Satisfaction Outcomes.

 
With the advent of Accountable Care Organizations (ACOs) and population health management initiatives, healthcare organizations are increasingly implementing technology and processes to encourage patient engagement. Incumbent in these efforts is the collection of more patient satisfaction data to help yield better decision making to promote lower cost delivery models and better clinical outcomes throughout the communities they serve.

As providers in all healthcare delivery networks strive to enhance patient satisfaction scores, they are all too often burdened by… [click here to download].
 
 

Looking for additional tips?

Over the coming months, Newport will provide a 4 part Tips Series which focuses on the invisible impact of credentialing. Check back soon!
 
 

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.
 
 

Happy Holidays from Newport Credentialing Solutions!

As 2016 comes to a close and we look towards 2017, all of the staff at Newport Credentialing Solutions would like to wish you a happy holiday and prosperous new year. Thank you for your continued loyalty and support!… Read More

As 2016 comes to a close and we look towards 2017, all of the staff at Newport Credentialing Solutions would like to wish you a happy holiday and prosperous new year. Thank you for your continued loyalty and support!

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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.
 
 

Advances in Technology Can Significantly Improve the Efficiency and Quality of the Credentialing Process

As seen in Becker’s Hospital Review: Written by Jodie Chant, MPA/HCA, BHSA, CPCS, RHIT, Principal Consultant, Jodie Chant Consulting, LLC Changes in the healthcare industry are placing a growing list of demands on health plans, hospital and health system medical staff services and credentialing departments. In the quest to keep up with increasing regulatory and… Read More

As seen in Becker’s Hospital Review: Written by Jodie Chant, MPA/HCA, BHSA, CPCS, RHIT, Principal Consultant, Jodie Chant Consulting, LLC

Changes in the healthcare industry are placing a growing list of demands on health plans, hospital and health system medical staff services and credentialing departments. In the quest to keep up with increasing regulatory and accreditation requirements driven by the Accountable Care Act (ACA), CMS, The Joint Commission and others, the time left for comprehensive credentialing activities is getting smaller and smaller. Yet, the obligation to ensure patient safety through a thorough, quality-driven credentialing investigation remains the same.

To relieve the time constraints of credentialing, hospitals, health systems and health plans are increasingly enlisting the services of credentials verification organizations (CVOs). A new technology is also growing in popularity, and from what I can see, it is a true game changer for the healthcare industry…
 
 
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 Billing All You Can For Locum Tenens Physicians?

As seen in Becker’s Hospital CFO: Written by Allyson Schiff, VP of Operations for Newport Credentialing Solutions The demand for locum tenens physicians has increased significantly over the past several years. Today, they are helping to meet temporary physician staffing needs in hospitals, group practices and clinics around the country. In addition to being able… Read More

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

The demand for locum tenens physicians has increased significantly over the past several years. Today, they are helping to meet temporary physician staffing needs in hospitals, group practices and clinics around the country.

In addition to being able to fill in for regular physicians when needed, there are plenty of other benefits associated with using locum tenens physicians. For example, significant cost savings can be achieved by not having to employ additional full time physicians, while administrative functions, like malpractice coverage,become the responsibility of the locum tenens group. While the benefits of utilizing locum tenens physicians are plenty, when not managed properly, there are also some risks including the potential for lost revenue…
 
beckers-hospital-cfoClick here to read the full article.
 
 
 
Becker’s Hospital CFO 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.

 

Enrollment Nightmares and Zombie Doctors

As seen in Becker’s Hospital Review: Written by Allyson Schiff, VP of Operations for Newport Credentialing Solutions In honor of Halloween, Newport Credentialing Solutions’ Vice President of Operations, Allyson Schiff, discusses the truly horrifying provider enrollment and credentialing issues that hospitals are constantly faced with. Click to learn how hospitals can protect themselves from wicked… Read More

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

newport-halloween-story-2In honor of Halloween, Newport Credentialing Solutions’ Vice President of Operations, Allyson Schiff, discusses the truly horrifying provider enrollment and credentialing issues that hospitals are constantly faced with. Click to learn how hospitals can protect themselves from wicked paperwork, zombie doctors, and other frightening issues.
 
 
As seen in Becker's Hospital ReviewClick here to read the full article, if you dare…
 
 
 
Becker’s Hospital Review is the original producer of this publication.
 
 

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.

 

Scott Friesen Recognized by Becker’s Hospital Review

As seen in Becker’s Hospital Review: 137 Healthcare Entrepreneurs to Know Our CEO, Scott Friesen, was recently honored by Becker’s Hospital Review as a leading entrepreneur in the healthcare space. The article recognizes those who are paving the way through innovation in the medical, IT, consumer and medical professional fields. Congratulations Scott!     Click… Read More

As seen in Becker’s Hospital Review: 137 Healthcare Entrepreneurs to Know

Our CEO, Scott Friesen, was recently honored by Becker’s Hospital Review as a leading entrepreneur in the healthcare space. The article recognizes those who are paving the way through innovation in the medical, IT, consumer and medical professional fields. Congratulations Scott!
 
 
Beckers Hospital ReviewClick here to read the full article.

Becker’s Health IT & CIO Review is the original producer of this publication.
 
 
 

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.
 
 
 

Five Tips for Achieving Provider Enrollment Success in a Complex Landscape: Tip 4

Tip 4: Don’t Overlook the Benefits of the Cloud. Cloud computing is becoming increasingly important to the healthcare industry. With the explosion of data from heightened adoption of electronic health records, the cloud offers a cost-effective, scalable solution for storing, accessing, and sharing information.The cloud also facilitates easy and increased cooperation between healthcare providers; which… Read More

Tip 4: Don’t Overlook the Benefits of the Cloud.

Newport-Credentialing-Tip-4Cloud computing is becoming increasingly important to the healthcare industry. With the explosion of data from heightened adoption of electronic health records, the cloud offers a cost-effective, scalable solution for storing, accessing, and sharing information.The cloud also facilitates easy and increased cooperation between healthcare providers; which is necessary for population health.

When housing data on a healthcare organization’s in-house servers, access to information is… [click here to download].
 
 

Looking for additional tips?

Over the coming months, Newport will provide a 5 part Tips Series which focuses on the key elements of a high performing provider enrollment department. Check back soon!
 
 

Five Tips for Achieving Provider Enrollment Success in a Complex Landscape: Tip 3

Tip 3: Avoid Credentialing and Provider Enrollment Mishaps Even with processes in place to ensure credentialing success, things can happen along the way. A provider may miss the deadline to submit information to the designated committee. During peak hiring and busy holiday seasons, the department head may lose track of who is coming on board.… Read More

Tip 3: Avoid Credentialing and Provider Enrollment Mishaps

Newport-Credentialing-Tip-3Even with processes in place to ensure credentialing success, things can happen along the way. A provider may miss the deadline to submit information to the designated committee. During peak hiring and busy holiday seasons, the department head may lose track of who is coming on board. When situations such as these occur, a provider is granted temporary privileges or provisional services. These “Band-Aids” let a provider work for several weeks or even months while hospital employees attempt to get the actual committee meeting and other processes in place necessary to grant credentialing privileges. However, these stall tactics come at a price because… [click here to download].
 
 

Looking for additional tips?

Over the coming months, Newport will provide a 5 part Tips Series which focuses on the key elements of a high performing provider enrollment department. Check back soon!
 
 

Five Tips for Achieving Provider Enrollment Success in a Complex Landscape: Tip 2

Tip 2: Eliminate Insurance Eligibility Denials at the Point of Scheduling When a provider joins a hospital they must apply for privileges to conduct clinical services.This process includes obtaining and validating all of the physician’s credentials including, but not limited to, board certifications, academic background, references, and previous work history.A committee must then approve the… Read More

Tip 2: Eliminate Insurance Eligibility Denials at the Point of Scheduling

Newport Credentialing Tip 2When a provider joins a hospital they must apply for privileges to conduct clinical services.This process includes obtaining and validating all of the physician’s credentials including, but not limited to, board certifications, academic background, references, and previous work history.A committee must then approve the provider (sometimes as many as three or four separate committees) before being granted credentialing privileges. Each hospital has its set times for when these committees meet to ensure a smooth process when providers come on board.

While payer dependent, the average enrollment… [click here to download].
 
 

Looking for additional tips?

Over the coming months, Newport will provide a 5 part Tips Series which focuses on the key elements of a high performing provider enrollment department. Check back soon!
 
 

Five Tips for Achieving Provider Enrollment Success in a Complex Landscape: Tip 1

Tip 1: View Provider Enrollment As a Critical Part of Your Revenue Cycle Credentialing and enrollment are critical business processes within the hospital, physician and allied health provider revenue cycle. When not managed properly they can, and will, negatively impact a healthcare organization’s revenue. If a provider is not enrolled correctly, they will not be… Read More

Tip 1: View Provider Enrollment As a Critical Part of Your Revenue Cycle

Newport Credentialing Tip 1Credentialing and enrollment are critical business processes within the hospital, physician and allied health provider revenue cycle. When not managed properly they can, and will, negatively impact a healthcare organization’s revenue. If a provider is not enrolled correctly, they will not be paid properly. Furthermore, incorrect or poorly managed credentialing and enrollment processes may also put a practice at risk for compliance violations and even liability for false claims.

To ensure every credentialing dollar is collected… [click here to download].
 
 

Looking for additional tips?

Over the coming months, Newport will provide a 5 part Tips Series which focuses on the key elements of a high performing provider enrollment department. Check back soon!
 
 

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.

 

Increase Revenue: Ensure Your Credentialing Department is Properly Staffed For New Hire Season

Ensuring that your credentialing department is adequately staffed to meet the new provider hiring rush is critical to maintaining revenue and increasing physician and patient satisfaction.   Click here to download the three ways Newport helps healthcare facilities like yours handle the on-boarding rush. Ready to learn more? Contact us at info@newport.theadleaf.com to speak with… Read More

Ensuring that your credentialing department is adequately staffed to meet the new provider hiring rush is critical to maintaining revenue and increasing physician and patient satisfaction.

 

Newport Credentialing Increase RevenueClick here to download the three ways Newport helps healthcare facilities like yours handle the on-boarding rush.

Ready to learn more? Contact us at info@newport.theadleaf.com to speak with a Newport representative about improving your revenue.

 
 
 
 

Strategies to Help Hospitals Prepare for Residency Season

As seen in Becker’s Hospital Review: Written by Allyson Schiff, Newport Credentialing Solution’s Vice President of Operations In just a few weeks the feeding frenzy will start as physician and medical residents become available for hire. For large health systems, this can mean the addition of several hundred new providers. In the chaotic rush to… Read More

As seen in Becker’s Hospital Review: Written by Allyson Schiff, Newport Credentialing Solution’s Vice President of Operations

In just a few weeks the feeding frenzy will start as physician and medical residents become available for hire.

For large health systems, this can mean the addition of several hundred new providers. In the chaotic rush to bring providers onboard as quickly as possible, a massive amount of work needs to happen. Adequate staffing, on the part of the health system is critical.

When enrollment processes are not managed properly, lost revenue can result in hundreds of thousands of dollars in a matter of months for a lower level provider. When enrolling highly specialized physicians such as neurosurgeons or plastic surgeons lost revenue can be significantly higher.
 
 
As seen in Becker's Hospital ReviewClick here to read the full article.

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

Key Considerations When Selecting a Credentialing Services Company

As seen in Becker’s Hospital Review: Written by Scott T. Friesen, CEO of Newport Credentialing Solutions Provider enrollment has become increasingly complex. Changes in reimbursement, narrow networks, and risk based contracts have created a new provider enrollment landscape which has left many administrators and providers scratching their heads for answers. For a small provider group,… Read More

As seen in Becker’s Hospital Review: Written by Scott T. Friesen, CEO of Newport Credentialing Solutions

Provider enrollment has become increasingly complex. Changes in reimbursement, narrow networks, and risk based contracts have created a new provider enrollment landscape which has left many administrators and providers scratching their heads for answers. For a small provider group, running the credentialing and enrollment process in-house is a manageable endeavor. However for hospitals and health systems, especially those with multiple locations, it can be a time-consuming and costly endeavor. This is especially true when relying on manual methods like paper documentation and email calendar alerts to run credentialing in-house.

With the financial implications of not properly managing credentialing and enrollment well known, more and more providers are turning to…
 
 
As seen in Becker's Hospital ReviewClick here to read the full article.

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

Healthcare Providers Can Often Overlook Critical Areas in Their Security Plans

As seen in Health Data Management: Written by David Meier, VP of Technology Solutions at Newport Credentialing Solutions With data breach news continuing to top headlines, hospitals and other healthcare organizations are stepping up their data security efforts. IT staff are working diligently to ensure EHR systems, accounting systems, and other patient-related software systems are… Read More

As seen in Health Data Management: Written by David Meier, VP of Technology Solutions at Newport Credentialing Solutions

With data breach news continuing to top headlines, hospitals and other healthcare organizations are stepping up their data security efforts. IT staff are working diligently to ensure EHR systems, accounting systems, and other patient-related software systems are secure.

Meanwhile, with the focus primarily on patient information, one-off areas like credentialing and enrollment are being overlooked, and that’s putting providers—and their identifiable information—at risk…
 
 
As seen in Health Data ManagementClick here to read the full article.

Health Data Management is the original producer of this publication.
 
 

RCM Perspective: Technology’s impact on credentialing and enrollment

As seen in Becker’s Health IT and CIO Review: Written by Anthony Cottone, Consultant for AtlantiCare Physician Group (APG) I have worked my entire professional career in the healthcare field and have a wealth of experience in physician practice management, medical billing (central billing office), software applications development, information technology management, including electronic medical records… Read More

As seen in Becker’s Health IT and CIO Review: Written by Anthony Cottone, Consultant for AtlantiCare Physician Group (APG)

I have worked my entire professional career in the healthcare field and have a wealth of experience in physician practice management, medical billing (central billing office), software applications development, information technology management, including electronic medical records implementation and integration.

Most recently I served as Director of Revenue Cycle Services at AtlantiCare Physician Group (APG), an organization I regard very highly.

As I begin to close out my career, I am now partially retired working as a consultant for APG following a move to the sunshine state, I can’t help but look back at how the healthcare industry has changed as a result of advances in technology. One area in particular where I personally have seen the benefits of technology (and an area that I believe is not discussed nearly enough) is the credentialing and provider enrollment space.
 
 
Beckers Health IT CIO ReviewClick here to read the full article.

Becker’s Health IT and CIO Review is the original producer of this publication.
 
 

2016: Conferences, Webinars, Newsletters, and more!

Here’s what Newport Credentialing has in store for 2016!   Conference Schedule AMGA National Meeting March 8th – 12th, 2016 Orlando, FL       Becker’s Hospital 7th Annual Meeting April 27th – 30th, 2016 Chicago, IL       HFMA Annual Conference June 26th – 29th, 2016 Las Vegas, NV       MGMA… Read More

Here’s what Newport Credentialing has in store for 2016!

 

Conference Schedule

Newport AMGAAMGA National Meeting
March 8th – 12th, 2016
Orlando, FL
 
 
 
Newport BeckersBecker’s Hospital 7th Annual Meeting
April 27th – 30th, 2016
Chicago, IL
 
 
 
Newport HFMAHFMA Annual Conference
June 26th – 29th, 2016
Las Vegas, NV
 
 
 
Newport MGMAMGMA National Meeting
October 30th – November 2nd, 2016
San Francisco, CA
 
 
 
More State & Regional Conferences Announced in 2016!
 
 

Webinar Schedule

Credentialing & Provider Enrollment 101
February 16th, 2016
Registration begins January 11th

Provider Enrollment Technology Solutions – The Right Tool for the Job Matters
March 17th, 2016
Registration begins February 12th

More to come! Further webinars will be announced.
 
 

Newport Quarterly eNewsletter

Each quarter, beginning in March 2016, Newport Credentialing Solutions will produce an informative eNewsletter to spotlight healthcare related issues with a focus on revenue cycle management. Our editorial staff will be working with some of Newport’s key customers and industry thought-leaders to bring a timely and insightful perspective on emerging trends in healthcare management best practices.

We want to hear from you…
 
We are in the process of building out our 2016 webinars, newsletters, and thought leadership pieces, and we would love your input on what topics would be of most interest to you. Please click here to submit any suggestions or ideas. Thank you!

 
 

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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The Evolution of Credentialing and Provider Enrollment

As seen in Becker’s Hospital Review: Credentialing and enrollment are critical business processes within the hospital, physician and allied health provider revenue cycle. When not managed properly, they can, and will, negatively impact a healthcare organization’s revenue. With regulatory requirements becoming more and more complex, incorrectly or poorly managed credentialing and enrollment processes also put… Read More

As seen in Becker’s Hospital Review: Credentialing and enrollment are critical business processes within the hospital, physician and allied health provider revenue cycle.

When not managed properly, they can, and will, negatively impact a healthcare organization’s revenue. With regulatory requirements becoming more and more complex, incorrectly or poorly managed credentialing and enrollment processes also put hospitals at risk for compliance violations and even liability of a false claim.
 
 
As seen in Becker's Hospital ReviewClick here to read the full article.

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

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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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.

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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.

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MGMA Connexion’s Magazine – What Lies Beneath the Surface

Reassessing your credentialing process could mean more money in your practice. Effective credentialing processes represent more than gaining approval from payers; they have a direct impact on your revenue cycle and physician alignment success. Yet many industry professionals lack the tools to create effective credentialing processes and might not have the necessary support from industry… Read More

Reassessing your credentialing process could mean more money in your practice.

MGMA ConnexionEffective credentialing processes represent more than gaining approval from payers; they have a direct impact on your revenue cycle and physician alignment success. Yet many industry professionals lack the tools to create effective credentialing processes and might not have the necessary support from industry executives to implement them. A deeper assessment of what the credentialing process represents — and how it can affect your bottom line — can provide the right incentives for change.

“The problem is that many professionals are in a reactive mode when it comes to credentialing,” says Donna Knapp, MA, FACMPE, independent consultant, MGMA Health Care Consulting Group. “It should be a continuous process with dedicated resources.”

Industry shifts have prompted more practice managers to recognize the importance of timely credentialing processes. A growing number of people acknowledge that by reducing the credentialing timeframe and obtaining Provider Identification Numbers (PINs) faster, you are able to bill for claims that would otherwise be written off with a slower credentialing process. For example, Medicare does not allow you to retroactively bill for claims unless you have a PIN.

Decreasing reimbursement, rapidly increasing costs, health information technology and the popularity of accountable care organizations (ACOs) have facilitated clinical, operational and financial integration in recent years. Prior to passage of the Patient Protection and Affordable Care Act, healthcare organizations (both hospital- and physician-owned) operated almost exclusively on a fee-forservice model, which can be likened to an all-you-can-eat buffet that rewarded providers for the number of services provided, not the clinical outcome of those services. The rise of ACOs prompted a gradual change in clinical, operational and reimbursement delivery in which some providers are reimbursed for the quality and successful clinical outcomes of their efforts.

As a result, hospitals and physician groups have begun to align in various forms of ACOs or integrated delivery networks to facilitate the shift to a fee-for-quality model that includes quality and clinical outcomes. For example, Kaiser Permanente, Mayo Clinic and Geisenger have had success with their fee-for-quality reimbursement models, which many large health systems are trying to emulate, according to industry experts.

The ability to optimize the credentialing process with operational and financial metrics is an essential component to this success. For example, data can be used to assess the days in enrollment (DIE) calculation for delegated and non-delegated payers. The ability to link gross charges to in-process credentialing applications, workflow tools, robust reporting, and analytics will facilitate physician alignment strategies, improve productivity, reduce credentialing timeframes and generate incremental revenue for healthcare organizations.

“Physician and allied health provider credentialing requirements have been overlooked by most hospitals and physician organizations,” says Pam D’Apuzzo, president, RR Health Strategies, a consulting group that specializes in physician practice management, coding and compliance. “This has led the OIG [Office of Inspector General] to scrutinize incident-to services. Organizations can mitigate their risk by using robust software to credential and bill for their services in a compliant manner.”

The number of hospital professionals who have initiated efforts to acquire and/or merge with other hospitals and physician organizations to reduce costs and improve clinical outcomes is on the rise, according to published reports. Hospital mergers and acquisitions activity increased 33 percent in 2010 from 2009, according to Healthcare Finance News. 1 Drilling down, 980 healthcare merger and acquisition deals valued at $227.4 billion took place in 2011, according to Modern Healthcare. 2 And many of those deals included physician medical groups.

Although we are seeing an increased interest in physician practice and hospital integration, history shows that some executives might not understand the operational and financial implications of setting up the robust billing, credentialing systems and operations required to successfully execute a physician-alignment strategy. As a result, many hospital professionals are seeing an increase in physician-related denials, frustrated doctors and lost revenue. For example, many see that credentialing denials are not easily reversed by payers and represent a loss of valuable revenue.

Credentialing

Credentialing requirements and challenges have been part of healthcare operations for decades, but market pressures have emphasized the need for efficient programs to capture available revenue and ensure workforce efficiencies. A dramatic increase in physician onboarding efforts and regulatory complexities from health plans and credentialing locations (for example, cross-credentialing providers at multiple or all locations) have forced professionals to seek workforce efficiencies, such as reducing administrative denials to collect all revenue.

“Having a robust workflow and analytics software solution that is tied to key performance metrics ensures that we are proactively managing our credentialing process,” says Motti Edelstein, director of managed care at North Shore – LIJ Health System, N.Y. Those metrics include provider-related denials, “collecting every dollar owed to our organization and ensuring that we are adequately staffed to handle provider growth,” he adds.

The state of credentialing software is a prime example of an industry failure to connect the credentialing and revenue cycles. In the late 1990s, software companies developed products that reduced the data-entry time needed to credential a physician by allowing doctors to create a database of physician demographic data and auto-populate applications from the same database. This reduced the processing time to submit all applications from approximately 40 hours to four hours. However, these products do not show how credentialing affects the revenue cycle.

More than paperwork

Healthcare professionals need to understand the different segments of the credentialing life cycle to gain perspective on the larger operational and financial processes.

They include:

  • Human resources (HR)
  • Hospital credentialing/privileging
  • Physician credentialing
  • Revenue cycle

If healthcare professionals fail to view the credentialing life cycle as an integral component of the revenue cycle, they will see increased denials, frustrated physicians, fragmented operations and lost revenue.

Ideally, physician credentialing will be considered in the following light:

  • It is an integral component of the revenue cycle, not a separate and siloed department.
  • It is one of the first steps in the revenue cycle and considered a continuous process.

Physician credentialing should be aligned with the HR and hospital credentialing process in these ways:

HR works closely with the hospital and physician credentialing departments to set a start date, integrate the hiring, privileging and physician credentialing process into one seamless process.

After a physician is hired, HR shares the news with the hospital credentialing department to initiate primary-source verification services.

Working concurrently, HR and credentialing department personnel tell the medical privileging committees/boards how many physicians will be up for review and privileging approval. If there are multiple medical privileging committees/boards in your organization, inform them in advance. Consider increasing the frequency of committees/ board meetings. Every day that passes without privileges means that physicians cannot see patients to generate revenue.

After a physician is hired and the medical privileging committee/board review is underway, HR and hospital credentialing department personnel ask the physician credentialing department to begin the data collection process. Collect as much demographic information and primary-source documentation as early as possible because there is significant overlap with the data these groups need to conduct their respective jobs. By leveraging HR and credentialing department data collection efforts, physician credentialing department personnel can prepare all credentialing documentation in advance and have enrollment applications ready for submission to payers once a physician is granted privileges.

Incorporate revenue-cycle concepts into physician credentialing to identify revenue loss and incremental revenue opportunities. Physicians are often granted privileges to practice at hospitals before they are enrolled with an organization’s insurance payer. Although this might fill the need for a specialist’s services, there is a negative revenue impact for the organization. For example, a physician starts seeing patients June 1 but has not been enrolled with the 20 insurance payers by the physician credentialing department. This physician generates gross charges of $5,000 in one day and $400,000 in gross charges over the course of 120 days. Now apply that scenario to 10 physicians and the total gross charges during that 120-day period is $4 million. Keep in mind that the physician credentialing department takes at least 120 days (four months) to obtain a PIN for all 20 insurance payers.

If the organization’s gross collection rate is 30 percent, the expected net cash translates into $1.2 million. However, many insurance payers do not retroactively reimburse for services conducted without a PIN, so the organization is faced with a $1.2 million write-off. If 50 percent of insurance payers retroactively reimburse, this still translates to a $600,000 write-off. Create robust metrics to identify, track, trend and manage the physician credentialing life cycle. The following metrics should be considered standard practice in any physician credentialing department:

  • Total physician credentialing opportunity: Total physicians x total payers x total locations* = Total opportunity
  • Total participating status: Total PINs / total opportunity
  • Total non-participating status: Total nonparticipating statuses / total opportunity
  • Total in-process status: Applications in the process of being granted PINs / total opportunity
  • Total financial impact of in-process applications: What is my gross charge impact, what is my net cash impact, how do my in-process applications affect my cash on hand, accounts receivable (A/R), etc.?
  • DIE — non-delegated payers: Total number of elapsed days from the time an application was submitted to an insurance payer compared with a standardized non-delegated metric (90 to 120 days).
  • DIE – Delegated payers: Total number of elapsed days from the time an application was submitted to an insurance payer compared with a standardized delegated metric (30 to 45 days).

Use physician credentialing workflow tools similar to those used in A/R and revenue cycle management to reduce credentialing timeframes, increase productivity and generate more cash. Recommendations for this department:

  • Create dynamic work lists that focus on the physicians and payers who generate the most revenue. This approach might be controversial for multispecialty groups but can help maximize the 80/20 rule and ensure that the majority of top-performers are fully enrolled.
  • Establish productivity tools to gauge credentialing specialist activities and ensure these activities are geared toward PIN completion. Develop productivity benchmarks and baselines to improve overall productivity. Industrywide productivity metrics do not exist for physician credentialing.

Physician credentialing needs robust reporting and analytics to better understand how departments are performing, identify process breakdowns and implement corrective actions.

Robust and easy-to-use reporting and analytic tools allow healthcare professionals to understand how their credentialing departments are performing. Most credentialing software companies provide limited reporting but do not link charges to in-process applications or DIE calculations that highlight payer performance.

Robust data analysis tools must be used during the physician credentialing life cycle so that professionals can see how their credentialing departments are performing.

When an operational process breakdown is identified, immediate corrective action should occur. For example, a credentialing department will compile a credentialing application and give it to a physician for signature in a short period of time. However, occasionally a physician is late returning the signed application. This delay, while inconsequential to the physician, has a real and direct revenue impact for the organization. By tracking and trending this process in the credentialing life cycle, the department can tell the physician how the delay affects the overall bottom line. When you identify a financial process breakdown, implement immediate corrective action. If a physician is delinquent in providing a signed signature page to the credentialing department but generates $5,000 of gross charges on a daily basis, analytics can identify the financial impact of that delinquency, which could prompt the physician to return the page sooner.

Analytics allow administrators to take the anecdote out of physician credentialing and compile statistical and financial data that can be used to provide incentives for physician adherence. Robust analytics can also be used with payers. Healthcare professionals can show specific examples of when payers have been delinquent in processing their physician credentialing applications. For example, healthcare professionals can identify how long it takes each payer to credential their physicians. If payers are taking longer than contractually obligated, show how the behavior affects your bottom line and use the data to negotiate better credentialing guarantees and/or contracted rates.

“Credentialing software can also help you identify breach of contract,” Knapp adds. “I don’t think people use this enough to keep payers honest with what they’ve told us they will do.”

As the healthcare environment shifts and changes, professionals must understand that if their physicians are not credentialed correctly, groups will not be paid correctly, and physicians will not be fully integrated with their healthcare organizations. The implementation of a clearly defined physician credentialing life cycle that encompasses physician credentialing metrics, workflow tools and robust reporting will result in a seamless hospital/ physician alignment strategy and increased net revenue.

Notes:

1 Healthcare Finance News – Hospital M&A Activity Jumped 33 Percent is 2010 – healthcarefinancenews. com/news/hospital-ma-activity-jumped-33-percent-2010

2 Modern Healthcare – M&A Activity Stayed Strong in 2011, Levin Says – modernhealthcare.com/ article/20120120/NEWS/30120996

 

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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Re-Defining Physician Credentialing Management Strategies

Increased M&A activity and physician alignment strategies has caused an unprecedented increase in physician on-boarding. Current physician credentialing management strategies are not equipped to handle this volume and require a shift from a “one to many” management structure to a “team based management structure.” Making this management shift will enable managers to increase specialization, scalability,… Read More

Increased M&A activity and physician alignment strategies has caused an unprecedented increase in physician on-boarding. Current physician credentialing management strategies are not equipped to handle this volume and require a shift from a “one to many” management structure to a “team based management structure.” Making this management shift will enable managers to increase specialization, scalability, and departmental stability.

Background

Today’s healthcare industry is undergoing unprecedented change. Decreasing reimbursement, soaring costs, the implementation of Healthcare IT initiatives (HIT), and the hotly debated Affordable Care Act (ACA) and its most recent manifestation, Accountable Care Organizations (ACOs), have converged to re-­ignite our health policy and economic discourse. Comprising approximately 18% of the gross domestic product (GDP), ideas on how to best manage the unknown future of US healthcare has generated many new and often radical solutions.

With the Patient Protection and Affordable Care Act only 11 months away from its 2014 start, the convergence of decreasing reimbursement, rapidly increasing costs, HIT, and the ACO model is playing itself out in the form of clinical, operational, and financial integration. Prior to the ACA, healthcare organizations (both hospitals and physicians) were operated and reimbursed based on a “fee for service” model. This “all you can eat” operational and reimbursement model rewarded hospitals and physicians by reimbursing the number of services provided rather than on the clinical outcome of those services. However, with the implementation of the ACO model, a sea shift in clinical, operational, and reimbursement delivery has occurred and both hospitals and physicians are now looking at reimbursement models based on the quality of care and the successful clinical outcomes of their efforts.

M&A Activity

In order to best facilitate the shift from a “fee for service” operational and reimbursement model to a “fee for quality” model (which links quality and clinical outcomes to financial reimbursement), many hospitals and physician groups have begun to morph themselves into various forms of ACOs or Integrated Delivery Networks (IDNs). Viewed as a way to improve clinical outcomes and reduce costs, many hospitals have begun significant efforts to acquire and/or merge with other hospitals and physician organizations. According to Healthcare Finance News, hospital M&A activity increased 33% in 2010 from 2009. 1 Further, according to Modern Healthcare quoting a study conducted by Irving Levin Associates (Norwalk, CT), 980 healthcare merger and acquisition deals valued at $227.4 billing took place in 2011. 2 “Among the healthcare sectors announcing 100 deals or more in 2011…” physician medical groups comprised “107 deals.”

This increase in M&A activity has caused many hospitals to look to integrate with as many physician groups as possible. However, what many of these hospitals have failed to realize is that despite integrating these physician practices into their healthcare organizations, many hospitals do not fully understand the operational and financial implications of setting up robust billing and credentialing systems and many hospitals do not have the expertise, staffing, or capital budgets to successfully execute on their physician alignment strategies. As a result, many hospitals are finding an increase in physician related denials, frustrated physicians and most importantly, lost revenue.

Adapt to Meet Growing Needs

The increase of M&A activity has caused many healthcare organizations to assess whether their current methods of managing their physician on-­boarding and credentialing life cycle continue to be effective. Prior to the increase in M&A activity, the physician on-­boarding and credentialing life cycle was managed by loosely affiliated departments across the health system. While their goal of bringing a provider into the healthcare organization are similar, various departments such as business development, human resources (HR), medical staff services and provider enrollment worked independently and rarely communicated efficiently or effectively.

Taken one step further, despite working as independent departments, because growing the rosters of employed providers is on every CEO’s 2013 strategic agenda, medical staff services and provider enrollment departments have seen a dramatic influx of new providers. In situations played out again and again, the business development department acquires a group practice, the HR department manages all of the group practice’s employment paperwork, but the provider is not `privileged or enrolled in a timely or efficient manner. The reason is for the inefficiency is simple. Traditional provider enrollment management techniques do not account for increased volume, growth, and complexity. The result, unfortunately, is that medical staff services and provider enrollment departments have become stretched, overworked, and inevitably fall behind. And, when this occurs, the healthcare organization lose valuable revenue dollars.

Traditional Physician Credentialing – “One To Many”

Traditionally, physician credentialing departments have not experienced high rates of growth and as such, have managed their providers in a one to many management structure. In the one to many management structure (as depicted below), a single physician credentialing specialist manages every component of a large number of providers and their physician credentialing life cycle.

This management structure has worked in the past because the volume and complexity of physician credentialing did not necessitate an alternative. Providers practiced at one or two locations, would only participate with 20-­25 health plans, and would have successful, long-­term careers.

However, in today’s high growth world of healthcare M&A, healthcare organizations are acquiring more and more hospitals and physician groups, physicians are being cross credentialed/enrolled across all healthcare facilities and new physicians are coming on-­board on a daily basis. Additionally, a shortage in physicians has necessitated an increase in the hiring of allied health providers. In order to address this risk, it is critical that physician credentialing managers re-‑assess the one to many management structure.

One issue with the one to many management structure is operational risk. By having one physician credentialing specialist manage every aspect of a large number of provider’s enrollment, there exists a centralization of domain expertise. This centralization of domain expertise works well when the physician credentialing specialist is able to stay on top of all of her duties. However, when that physician credentialing specialist becomes sick, is out on medical leave, is on vacation, falls behind on her work, or quits, the work for all of the providers that she is managing comes to a screeching halt. This poses a significant risk to both work continuity and revenue.

A second issue with the one to many management structure is scalability. Understanding that physician credentialing specialists are falling further and further behind due to the increasing number of providers coming on-­board, it is very difficult to scale physician credentialing staff to meet growing operational demands. By managing every aspect of a large number of provider’s enrollment, it is critical to hire physician credentialing specialists with deep expertise and experience. Further, it is critical that physician credentialing specialist provide value from day one. However, as many managers know, finding physician credentialing specialists with deep expertise is often challenging. As a result, management is left with no choice but to hire credentialing specialists with less experience and hope for the best.

An Alternative – Team Based Provider Enrollment Management – “Many To Many”

The response to concerns regarding the one to many management structure is a team based management structure. Taken from the successful team based management techniques used in revenue cycle management, the team based management structure creates specialized teams to manage each of the specific tasks of the credentialing life cycle.

As the illustration depicts above, rather than have one person manage a large number of providers (and all of the risks that accompany that structure), task based teams are created. These teams are created based on each task of the credentialing life cycle. For example, one team might be a data entry team, a par/non-­par team, an initial CAQH and CAQH re-attestation team, an applications processing team, a credentialing follow up team, or a re-­credentialing team. Each team should be managed by a team lead and in turn, the team lead should be managed by a manager or director.

The benefits of a team based management structure is specialization and increased efficiency. Consider Henry Ford’s pioneering approach to car manufacturing. Each team was assigned a task and by conducting the same task again and again, the teams became specialized and quicker at their tasks. This also applies to the credentialing life cycle. By enabling someone to conduct data entry for new providers all day long, or when they do credentialing follow up all day long, they gain specialized domain knowledge and become faster at the specific task.

Further, by managing your credentialing life cycle in a team based management structure, you create a scalable foundation upon which to growth your credentialing enterprise. Refer back to the Henry Ford model. When demand for his cars increased, all Ford had to do was hire additional people and train them on one task. The same applies to credentialing team based management. When provider volume increases, rather than having to find and train a highly experienced credentialing specialist to manage all aspects of the credentialing life cycle, all you have to do is add additional staff and train them on the one task. The results are quicker transition, a quicker learning curve, and greater departmental stability.

Finally, a team based management structure provides stability and increased morale in your department. In the team based model, if a data entry specialist leaves your department, you only have to find a new data entry specialist, not a highly skilled credentialing specialist. In addition, by breaking down what is often seen as an overwhelming avalanche of work into small, manageable tasks, your staff is able to easily understand what needs to be done and set their mind toward accomplishing that task. The concept of “accomplishable tasks” dramatically increases staff morale both for the individual staff member as well as for the entire department.

Results – So What?

So how does the team based management structure compare to your credentialing department? Do you see the same problems that have been mentioned above and do you also see the benefits of the task based approach?

The “So What?” is simple. The dramatic increase in work associated with increased provider on-­boarding has created an environment which cannot be sustained. Smart managers have to find a way to easily scale their departments into specialized teams. Those that consider the benefits of a team based approach will experience all of the benefits mentioned above and in turn, will gain increased control over their departments and their careers.

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 comprehensive services dedicated to the physician credentialing life cycle. Newport’s industry defining, patent pending software and services enables clients to meet the operational and financial demands of a re-defined Credentialing Life Cycle.

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

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Re-Defining Physician Credentialing Software – A New Approach

The upcoming reimbursement shift from “fee for service” to “fee for quality” has generated an increased focus on population health management. In order to ensure a sufficient clinical delivery base, healthcare organizations have begun to consolidate clinical providers at an unprecedented rate. Current credentialing software products are not equipped to handle the complexities of a… Read More

The upcoming reimbursement shift from “fee for service” to “fee for quality” has generated an increased focus on population health management. In order to ensure a sufficient clinical delivery base, healthcare organizations have begun to consolidate clinical providers at an unprecedented rate. Current credentialing software products are not equipped to handle the complexities of a highly distributed, multi-provider, quality driven reimbursement model. Credentialing software must offer an open and revenue centric solution which empowers healthcare organizations to meet the operational and financial demands that population health management requires.

Background

Today’s healthcare industry is undergoing unprecedented change. As a result of the Affordable Care Act (ACA), CMS and commercial payers are moving from a “fee for service” reimbursement model to a “fee for quality” model. One of the primary ways that healthcare organizations are looking to capitalize on the “fee for quality” reimbursement model is to move toward population health management. Defined roughly as providing the complete continuum of clinical care for a geographic population from pre-admission wellness, to service line clinical delivery, to post discharge wellness follow up, the goal of population health management is simple: keep people from having to go to the hospital and in the event that they have to go to the hospital, provide the right care across all specialties so that once they are discharged, they do not have to go back to the hospital. In response for successfully accomplishing the above, any cost savings that are attained will be shared between CMS/commercial payers, and the healthcare organizations/providers.

The move to population health management has forced healthcare organizations to ensure that they have the appropriate number of primary care and specialty providers in order to successfully treat their geographically based patient populations. This in turn has had a dramatic effect on the revenue of healthcare organizations and has gained the attention of every healthcare leader in the country. Whereas healthcare leaders were previously concerned primarily with core revenue cycle concepts including scheduling, insurance verification, authorization, charge capture, medical coding, and accounts receivables follow up, healthcare leader’ attention is now focused on the direct linkage of provider on-boarding, linking those providers to the appropriate payer(s), and identifying the financial impact of those linkages to their ability to collect on their population health delivery initiatives. From a credentialing and provider enrollment perspective, healthcare leaders are realizing that their current credentialing software capabilities are limited at best and that new alternatives are critical to successfully maximize their shift toward population health management.

Population Health Management and Provider Credentialing Software

In order to understand the impact of population health management on the credentialing
software industry, we should first look at how healthcare organizations are a) hiring more and more providers to meet a critical mass of needing to employ primary and specialty providers, b) moving non-critical, ambulatory services out of the hospital and into off-site locations and c) how healthcare leaders are mandating that all of their healthcare providers provide service across all clinical delivery locations.

In order to ensure that healthcare organizations can meet the demands of population health management, as well as reap the benefits of attained cost savings and improved patient outcomes, healthcare leaders and organizations have been acquiring physicians and allied health providers at an unprecedented rate. According to a January 9th, 2012 article in Fierce Healthcare, “Hospitals’ physician employment jumped 32 percent from 2000 to roughly 212,000 physicians in 2010, according to the 2012 edition of AHA Hospital Statistics. That means hospitals employ almost 20 percent of all physicians, notes a Hospitals & Health News Daily article.”

Fierce Healthcare continues, “What’s more, the amount of hospitals employing hospitalists rose from 29.6 percent in 2003 to 59.8 percent in 2010.” 1 The impact of this hiring binge has been a negative impact on healthcare organization’s revenue due, in part, to inadequate credentialing software and services skill sets.

Additionally, due to increasing costs as well as a premium on hospital square footage, increasing numbers of healthcare organizations are moving non-critical, ambulatory services out of the hospital setting and into off-site locations. The concept is simple, take non-critical, low revenue generating services out of the hospital and replace them with critical, high revenue generating services. No longer are hospitals being viewed as an “all in one” clinical service provider. Rather, they are being viewed as service delivery experts for only the most complex clinical services. As a corollary, non-critical, low revenue generating services are being moved off-site and directly into the community. The impact of this shift is a) to ensure that providers are managing the health of their population within the community itself and b) the ambulatory centers will serve as a feeder for any in-patient, hospital based services.

As a result of this shift, healthcare leaders are mandating that their employed providers provide services across all off-site locations. For example, providers that previously provided services at only one or two locations are now providing services at multiple locations (both within their employed healthcare organization as well as with competing healthcare organizations).

With this population based and multi-location delivery shift, healthcare leaders are realizing that they need to credential and enroll their providers across all locations. However, in doing so, they are realizing that the credentialing and enrollment process becomes incredibly more complicated. When coupled with the negative revenue impact that not correctly cross credentialing their providers entails, healthcare leaders are realizing that existing credentialing software tools are not equipped to meet these newly emerged, multi-faceted demands.

Credentialing Software – A Brief History

In order to best understand how the credentialing software industry can meet population health based demands, we should first understand the historical evolution of the credentialing software industry. Prior to the advent of credentialing software, most government and managed care provider enrollment applications were filled out manually (e.g., paper and pen). Providers would complete 20-25 applications with an average length of 30-40 pages. Typically, it would take 2-3 hours to complete one application and all data was paper based. In the late 1990s, software companies developed software that reduced the data entry time needed to complete a credentialing application by allowing a physician to enter demographic data into a client server database and “auto-populate” applications from the same database. As a result, physicians only had to enter data one time, but in doing so, could populate all 25 applications at the same time. Whereas it may have previously taken a physician 40 hours to populate and submit all of his/her application(s), it now only took 4 hours.

While tremendously innovative at the time, most credentialing software tools have not evolved past this point. In particular, credentialing software tools have not adapted to the demands of a population health based management in the following ways:

  • They do not offer a cloud based, multi-location, 24/7 web accessibility
  • Because they are client server based, they do not have the programming flexibility to adapt to the changing healthcare environment in a rapid and flexible manner.
  • Enhancements, if any, are rolled out sporadically, and only for those users who are
    willing to pay an enhanced fee.
  • They do not offer easy to understand cross-location operational and financial performance metrics. It is incredibly difficult to understand an organization’s performance from an Institution, Facility/Location, Department/Office, Provider, or Payer perspective.
  • They do not offer flexible, system generated work list and follow up capabilities
  • They do not offer robust analytics that allow the user to conduct data analysis so as to identify operational, financial, or payer bottlenecks
  • They do not offer quality assurance mechanisms
  • They do not offer productivity standard tracking mechanisms
  • They do not incorporate revenue and physician credentialing life cycle metrics into one unified tool
  • They do not offer the ability to link gross charges to their in-process applications
  • They do not offer Key Performance Indicators (KPIs)
  • They do not offer revenue cycle metrics such as: Days In Enrollment (DIE) calculations
  • They do not offer payer performance metrics to keep payers accountable
  • They do not offer a way to link provider credentialing data with provider clinical outcome data

Based on this assessment, it is evident that the existing credentialing software tools have not adapted to the demands of a population management reimbursement and a new approach to credentialing software must be created.

Without tools to meet these growing demands, healthcare organizations will experience an increase in credentialing related denials, frustrated providers, and a loss of critical revenue.

Credentialing Software – A New Approach

In order to meet the demands of a population health management, health leaders must ask their credentialing software vendors for new ways to help them meet their combined cross-location, revenue centric needs. Health leaders would be well positioned if they demanded the following credentialing software functionality:

  • Cloud based, Multi-Location, 24/7 Web Accessibility. Credentialing and revenue data should be available to anyone who has access to the internet and has a user name and password. All data should be stored “in the cloud” and healthcare managers and providers should be able to access their credentialing data and identify where they are in the enrollment process so as to ensure that they are not losing revenue due to delayed credentialing timeframes.
    Another benefit of “being in the cloud” would be a dramatic reduction in upfront capital expenditures. No longer would a healthcare organization need hardware, servers, software, or staff to subsidize their credentialing systems. Rather, all of their software would be hosted by a HIPAA and HITECH approved vendor and the vendor would bear all hosting and data encryption costs.
  • Institution, Facility/Location, Department/Office, Provider, or Payer Operational and Financial Performance Metrics. In this instance, healthcare leaders and managers would be able to instantly identify how their entire institution is performing from an operational and financial perspective. Healthcare leaders and managers would be able to move from a 30,000 foot understanding of their institution’s performance, to a 1 foot understanding of a particular provider’s performance by simply “drilling down” from the highest institutional level down to the provider level. As most successful leaders realize, understanding current performance is the first step in improving and/or maintaining
    organizational and financial performance.
  • Flexible, System Generated Work List and Follow up Capabilities. Healthcare leaders and mangers must require flexible, system generated work lists that their staff can use to meet the growing on-boarding and cross-credentialing demands of their growing organization. Gone are the days of using post-it notes or calendar reminders to conduct credentialing follow up. Rather, credentialing software should drive each step in the credentialing life cycle. Further, by using a system generated work list methodology, healthcare leaders and managers can gain full control over the work of their staff as well as establish accountability metrics.
  • Robust Analytics to Allow the User to Conduct Data Mining and Analysis. Healthcare leaders and managers should require robust analytics to easily identify operational, financial, or payer bottlenecks. Healthcare managers should be able to instantly identify which providers are participating, non-participating, or in process as well as be able to identify the financial impact (positive or negative) of their in-process applications. Additionally, analytics should be easy to use and value-add. Analytics should help identify process breakdowns before they become financial breakdowns. Not the other way around.
  • Quality Assurance Mechanisms and Tools. Healthcare leaders and managers should require the ability to track, trend, and monitor the quality of the credentialing work that their staff is conducting. Currently quality monitoring mechanisms do not exist within the credentialing software industry. Quality monitoring and staff feedback/training should be proactive and on going. It should not be something that exists as an “unknown.”
  • Productivity Standard Tracking Mechanisms and Tools. Healthcare leaders and managers should also require the ability to establish and track productivity metrics and statistics. What actions is your staff taking on an hourly, daily, or weekly basis? Are these actions geared toward obtaining a PIN faster or are they miss-guided efforts? Is your staff wasting critical time during the day or maximizing their time for the good of your organization? The ability to establish and track individual staff productivity metrics should make the staff more efficient and ensure that you are not losing revenue due to inappropriate staff activities.
  • Combined Revenue Cycle and Credentialing Concepts. Key to meeting the demands of population health management initiatives is to understand the financial impact of your credentialing efforts. Current credentialing software tools do not spend any time connecting revenue cycle and credentialing metrics. However, this puts the healthcare leader at a significant disadvantage because a) he/she does not have the correct revenue cycle and/or credentialing metrics to track in the first place and b) he/she does not know what revenue they are losing because their providers are not correctly cross credentialed, or credentialed at all. Examples include:
    • Linking gross charges to “in-process” applications
    • Establishing payer performance metrics such as Days In Enrollment (DIE) for delegated and non-delegated payers
    • Stratifying credentialing follow-up efforts based on providers with the highest associated gross charges first, and then working on the providers with lower associated gross charges second.
    • Following up on credentialing tasks based on a system generated tickle timeframe as opposed to post-it notes and calendar reminders
    • Provider Performance Metrics. In order to facilitate provider participation, software tools should exist which track provider performance and adherence. How long did it take a provider to sign a credentialing application(s), what was the turn around time of the signature process and what are the gross charges, by payer that were affected by the provider’s quick or delayed turn around? Healthcare leaders and managers can effect more timely provider response times if they have the data show the provider whether they are or are not adhering in a timely manner.
    • Payer Performance Metrics. As with facilitating provider participation, software tools should exist which track payer performance. Healthcare leaders need the data to hold payers accountable for their credentialing processing delays. Particularly the managed care contracting departments housed in both hospitals and academic medical centers. The ability to maximize billable charges rests solely in the skills of the managed care contracting department and they need as much data driven assistance as possible when negotiating managed care contracts for your organization. By collecting payer performance data, and publishing that data in a cloud based environment for all healthcare leaders to view, healthcare organizations should be able to incent and/or negotiate improved payer performance rates and turn around times.
    • Provider Score Card Linking Clinical Outcomes With Provider Credentials. As payers continue to link reimbursement with quality outcomes, credentialing software should be able to connect a provider’s primary source documentation verifications (e.g., background checks, criminal history, sanctions monitoring, quality outcomes report cards, etc.) with their patient outcomes. There is a growing trend to link both primary source documentation verification and continuing education credits with quality outcomes so as to get a more complete reimbursement picture. Forward thinking credentialing software vendors will create the ability to link all three components together as well as provide a value add score card which payers and healthcare leaders can evaluate provider performance.

     

    Results – “So What?”

    The “So What?” is simple – After an assessment of the growing demands of population health management, it is clear that as the industry continues to evolve, forward thinking healthcare leaders should demand more from their credentialing software vendors. Healthcare leaders should conduct a needs assessment of their current credentialing software tools and speak with their credentialing departments to see what additional tools they believe that they need to meet the increasing demands of population health management. Healthcare leaders that do not take the time to do so will run the risk of increased credentialing denials, frustrated providers, and ultimately lost revenue. Those leaders that do take the time will be well positioned to exceed the demands of population health management.

    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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