Thought Leadership

New Perspectives To Improve the Credentialing Industry

Category: Provider Enrollment

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…

 
 

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

Healthcare M&A Activity Elevates The Importance Of Provider Data Management

As seen in Health IT Outcomes: Written by Scott Friesen Following a record year of healthcare mergers and acquisitions (M&A), there are no signs of a slowdown. In fact, according to data compiled by Bloomberg, in the first quarter of this year, M&A activity reached a record $156 billion. Philadelphia-based Einstein Healthcare Network and Jefferson… Read More

As seen in Health IT Outcomes: Written by Scott Friesen

Following a record year of healthcare mergers and acquisitions (M&A), there are no signs of a slowdown. In fact, according to data compiled by Bloomberg, in the first quarter of this year, M&A activity reached a record $156 billion. Philadelphia-based Einstein Healthcare Network and Jefferson Health announced their intent to merge. Meanwhile Grand Rapids-based Spectrum Health, one of Michigan’s largest not-for-profit health systems, and Lakeland Health, a three-hospital system based in St. Joseph, signed a letter of intent to merge. These are just two of many M&A examples.

While hospitals and health systems have gotten better at post-M&A integration throughout the years, one area continues to be overlooked — 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…
 
 
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Health IT Outcomes 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.
 
 
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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…

7 Recent RCM Tips

As seen in Becker’s Hospital CFO Report: Written by Kelly Gooch Here are seven revenue cycle management tips from industry experts, published by Becker’s Hospital Review since Feb. 22. Patrick Doyle, senior vice president at Newport Credentialing Solutions Tara Dwyer, vice president of audit operations at Xsolis Mark Hendricks, vice president of product management at… Read More

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

Here are seven revenue cycle management tips from industry experts, published by Becker’s Hospital Review since Feb. 22.

Patrick Doyle, senior vice president at Newport Credentialing Solutions
Tara Dwyer, vice president of audit operations at Xsolis
Mark Hendricks, vice president of product management at nThrive
Eric Ritchie, COO of Grantsville, W.Va.-based Minnie Hamilton Health System
Kevin Lathrop, president of TriZetto Provider Solutions, a Cognizant company
Eric Nilsson, chief technology officer of SSI Group
Kenneth Miller, senior revenue cycle management specialist at Cantata Health

View all of the tips here!

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

Dealing with Denied Claims: The Financial Impact of Credentialing and Provider Enrollment

As seen in Group Practice Journal: Written by Patrick Doyle Your healthcare revenue cycle has many moving parts. The most successful practices routinely evaluate processes to identify cost-reducing and profit-increasing potential. A frequently overlooked component during evaluation is credentialing as it relates to provider enrollment. The reason for this lapse is many group practices lack… Read More

As seen in Group Practice Journal: Written by Patrick Doyle

Your healthcare revenue cycle has many moving parts. The most successful practices routinely evaluate processes to identify cost-reducing and profit-increasing potential. A frequently overlooked component during evaluation is credentialing as it relates to provider enrollment. The reason for this lapse is many group practices lack detailed insight into provider data and are therefore unable to measure the impact it has on their overall revenue cycle. As a result, groups lose revenue when they are unable to collect all that is owed.

Denied claims caused by credentialing-related issues have an obvious impact on a provider’s reimbursements. The inability to collect on these denied claims nearly always leads a provider’s practice to write off the claim and stop 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. Yet, lacking awareness that a provider enrollment problem exists, it is impossible to know
the financial impact it has on a revenue cycle. And, it is impossible to fix a problem if you are unaware it exists.

To read the full article, please go to Group Practice Journal!

How Provider Enrollment Impacts Patient Satisfaction

As seen in Becker’s Hospital Review: Written by Scott Friesen, CEO of Newport Credentialing Solutions The rise of healthcare consumerism has significantly elevated the importance of patient satisfaction. As deductibles continue to climb, patients have become increasingly more vocal in their care and choice of provider. If they aren’t happy, they will take their business… Read More

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

The rise of healthcare consumerism has significantly elevated the importance of patient satisfaction.

As deductibles continue to climb, patients have become increasingly more vocal in their care and choice of provider. If they aren’t happy, they will take their business elsewhere, often leaving a negative online review in the process.

As hospitals and health systems continue to look for new ways to improve patient satisfaction, one area that is typically overlooked is provider enrollment. While commonly viewed as a back-office function, provider enrollment can have a significant impact on patient satisfaction and the overall hospital experience. If a provider is not enrolled with their respective provider, the patient…
 
 
As seen in Becker's Hospital ReviewClick here to read the full article…
 
Becker’s Hospital Review 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.

TractManager Acquires Newport Credentialing Solutions

CHATTANOOGA, TN, DALLAS, TX. Feb. 20, 2018/Business Wire. TractManager, Inc., the healthcare industry’s largest supplier of strategic sourcing and contract lifecycle management (CLM) solutions, has acquired Newport Credentialing Solutions, the leader in cloud-based credentialing and provider enrollment software and services. “Newport Credentialing Solutions is an exciting addition to our corporate family,” said Trace Devanny, chief… Read More

CHATTANOOGA, TN, DALLAS, TX. Feb. 20, 2018/Business Wire. TractManager, Inc., the healthcare industry’s largest supplier of strategic sourcing and contract lifecycle management (CLM) solutions, has acquired Newport Credentialing Solutions, the leader in cloud-based credentialing and provider enrollment software and services.

“Newport Credentialing Solutions is an exciting addition to our corporate family,” said Trace Devanny, chief executive officer of TractManager. “Newport’s solutions streamline the physician enrollment process and enable the proactive management of the complex credentialing lifecycle. In an increasingly challenging financial environment, Newport’s ability to optimize the provider revenue cycle through enrollment automation is a much-needed solution that immediately impacts the bottom line of physician practices, hospitals, and health systems.”

Since its founding in 2009, Newport has focused on helping providers take control of their credentialing lifecycle, thereby generating more income in less time. Newport views credentialing as an integral part of the revenue cycle as providers who are not enrolled correctly will not be paid correctly. Newport’s clients include some of the largest academic medical centers, health systems, and multi-specialty group practices in the United States.

“We’re excited to join forces with TractManager,” said Scott Friesen, Founder and CEO of Newport Credentialing Solutions. “Enrolling a provider and then maintaining that provider’s enrollment status is challenging. We developed the industry’s first cloud-based workflow, analytics, and business intelligence credentialing platform to overcome that challenge, and I can’t think of a better home for us to continue to evolve our solutions and accelerate our growth and market penetration than TractManager.”

Newport’s customized professional and support services wrap around the proprietary software and maximize the value of the credentialing platform. Donald A. Deieso, Ph.D., Chairman of TractManager’s Board of Directors, and Operating Partner for Arsenal Capital Partners, noted that, “With the addition of Newport to the TractManager family, we continue to advance our mission of building an exceptional organization that can truly transform our healthcare system for the benefit of all.”

As an introduction to TractManager, we are holding an informational webinar, this Thursday, February 22nd at 10:00am EST. Please register here.

 

About Newport Credentialing Solutions

Newport Credentialing Solutions is the nation’s premier provider of cloud-based, workflow and analytics software, and cloud-enabled services dedicated to the credentialing lifecycle. Newport’s clients include some of the largest academic medical centers, health systems, and multi-specialty group practices in the United States.
 

About TractManager

TractManager’s healthcare-specific application suite serves three out of five U.S. hospitals. Serving the healthcare industry with integrity for more than 30 years, TractManager is the first-mover in strategic sourcing and enterprise contract lifecycle management. Our advisory services wrap around each solution component, optimizing purchasing and service category management, while supporting best-practice contracting processes. The company’s strategic sourcing division, MD Buyline, includes Hayes, the industry leader in providing clinically focused, evidence-based research and analysis to health plans, insurers, hospitals, healthcare systems, ACOs and government agencies, and MedApproved, a new product approval workflow solution. The MediTract division supports hospitals and healthcare facilities with an enterprise contract lifecycle solution. Together, we are dedicated to helping our clients reduce their capital and non-labor costs, and conform their contract, policy, and procedure management to meet regulatory requirements.
 

About Arsenal Capital Partners

Formed in 2000, Arsenal Capital Partners is a leading New York-based private equity firm that invests in specialty industrial and healthcare companies. Arsenal targets businesses with the potential for further value creation by working closely with management to accelerate growth and leverage the firm’s operational improvement capabilities. Since inception, Arsenal has raised institutional equity investment funds totaling $3 billion.
 

The Emily Program, an Affiliate of the University of Minnesota Medical School, Selects Newport Credentialing Solutions to Manage Provider Enrollment

As seen in Enhanced Online News LYNBROOK, N.Y.–(EON: Enhanced Online News)–Newport Credentialing Solutions, the industry’s leading provider of healthcare credentialing and payer enrollment solutions, today announced it has been selected by The Emily Program to oversee the payer enrollment process for the organization’s multi-state network of affiliated providers. One of the premier treatment centers for… Read More

As seen in Enhanced Online News

LYNBROOK, N.Y.–(EON: Enhanced Online News)–Newport Credentialing Solutions, the industry’s leading provider of healthcare credentialing and payer enrollment solutions, today announced it has been selected by The Emily Program to oversee the payer enrollment process for the organization’s multi-state network of affiliated providers. One of the premier treatment centers for eating disorders in the United States, The Emily Program has more than 500 employees across four States with the goal to provide its services nationwide.

“Newport’s knowledge of the provider enrollment process and established relationships with payer groups is a huge asset to our organization,” said Nam Hoang Lew, Chief Financial Officer for The Emily Program. “The Emily Program works with a larger number of payers. Overseeing these relationships and ensuring our multi-state network of providers are enrolled properly was just too much to manage in-house. Newport provides the expertise and best practice processes to ensure enrollments are managed efficiently and accurately so we get paid.”

Newport offers a unique cloud-based credentialing and provider enrollment platform and unmatched provider enrollment domain expertise. Newport’s staff is highly trained and understands what is required to manage the credentialing life cycle successfully. In addition to managing time-consuming processes such as verifications and proactive monitoring of outstanding applications, Newport works closely with insurance payers to ensure enrollment processes move along as quickly as possible for improved revenue.

About The Emily Program
The Emily Program is a University of Minnesota Medical School Affiliate. Founded in 1993, The Emily Program helps people of all ages and genders who struggle with eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, compulsive overeating, and related mental health and body image issues throughout Minnesota, Ohio, Pennsylvania and Washington.

Click here to see the full press release…
 
 

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.
 
 
 

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

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

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

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

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

Click here to read the full article…

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

DOWNLOAD: The Invisible Impact of Credentialing

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

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

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

 
 
 
 

The Invisible Impact of Credentialing: Tip 4

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

Tip 4: Consider Overlooked Costs.

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

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

Looking for additional tips?

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

 

The Invisible Impact of Credentialing: Tip 3

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

Tip 3: Prevent Surprise Medical Billing.

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

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

Looking for additional tips?

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

 
 

Upfront Provider Enrollment Verification Can Greatly Minimize Claim Denials

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

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

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

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

Hidden Ways Hospitals Can Save Money

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

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

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

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

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

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.
 
 

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.
 
 

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.
 
 
 

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!
 
 

4 Tips to Avoid Lost Revenue This Summer

As seen in Becker’s Hospital Review: Written by Allyson Schiff Newport Credentialing Solution’s Vice President of Operations Summer has officially begun, and employees across the country are heading out on vacation. For the healthcare industry, which operates business as usual regardless of the season, inadequate staffing coupled with poor management of business-critical processes often negatively… Read More

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

Summer has officially begun, and employees across the country are heading out on vacation. For the healthcare industry, which operates business as usual regardless of the season, inadequate staffing coupled with poor management of business-critical processes often negatively impact a hospital’s revenue.

Consider, for example, credentialing and privileging which necessitate on-going management and monitoring. These functions require proactive and ongoing monitoring of licenses, sanctions, exclusions and much more. These processes cannot wait for someone to return from summer break as the financial repercussions of incorrectly enrolling providers with payers are huge. If a provider is not enrolled or credentialing expires, a provider will not be…
 
 
As seen in Becker's Hospital ReviewClick here to read the full article.

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

Billing Begins with Insurance and Provider Enrollment Verification

As seen in AMGA’s Group Practice Journal: Written by Patrick Doyle Insurance verification plays an important role in a practice’s revenue cycle management efforts. When verifications are not managed properly, lost revenue can be significant. In addition to the provider’s time, other investments are at risk of being written off when a patient’s insurance is… Read More

As seen in AMGA’s Group Practice Journal: Written by Patrick Doyle

Insurance verification plays an important role in a practice’s revenue cycle management efforts. When verifications are not managed properly, lost revenue can be significant. In addition to the provider’s time, other investments are at risk of being written off when a patient’s insurance is no longer valid, including materials and time spent on case preparation. This is why 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 overlook a process as important as insurance verification—provider enrollment verification. Similar to a patient not having valid insurance, when a provider is not properly enrolled with a health plan, his/her encounters will be written off. Given just how many patient encounters a provider has in a given day, week, or month, the financial impact can be significant. Yet few practices have processes in place for provider enrollment verification as stringent as insurance verification.

Insurance verification and provider enrollment are the start of the revenue cycle. If they aren’t viewed as such, they should be. When scheduling patients, provider enrollment verification must become a standard part of the scheduling process alongside insurance verification. When a patient isn’t covered, an encounter will not occur. Providers should follow this same process when an enrollment is not complete.
 
 
AMGA

Download

The full version of this article can be found in the June issue of Group Practice Journal, the flagship publication of AMGA. Please click here to view.
 
 

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.
 
 

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

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

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

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

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

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

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

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

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

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

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

 
Q. How should we conduct our Quality Assurance?

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

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

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

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

Quality Assurance should occur in two phases:

a. Initial Quality Assurance Review

b. Subsequent Quality Assurance Reviews

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

a. Pick 10 provider enrollment applications.

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

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

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

 
Q. Is Quality Assurance Feedback Important?

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

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

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

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

 

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Privacy Concerns with Your PECOS Account

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

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

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

Q. What are the main benefits associated with PECOS?

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

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

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

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

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

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

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

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

 

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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.
 
 

Poorly Managed Provider Enrollment Verification Processes Can Prove Costly

As seen in Western PA Healthcare News: Written by Patrick Doyle, Vice President, Newport Credentialing Solutions In the evolving and complex healthcare landscape, providers are relentlessly looking for new ways to improve revenue as they battle rising costs and shrinking reimbursements. With the financial implications of having to write off an encounter well known, it… Read More

As seen in Western PA Healthcare News: Written by Patrick Doyle, Vice President, Newport Credentialing Solutions

In the evolving and complex healthcare landscape, providers are relentlessly looking for new ways to improve revenue as they battle rising costs and shrinking reimbursements. With the financial implications of having to write off an encounter well known, it is no surprise significant time and effort is being spent on insurance verification. Practices are going to great lengths to ensure a patient’s insurance is verified well in advance of an encounter. If the patient is not covered, the procedure is not scheduled.

With so much time and technology used to help providers avoid upfront insurance eligibility denials, it is interesting to note…
 
 
As seen in Western PA Healthcare NewsClick here to read the full article.

Western PA Healthcare News 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.
 
 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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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!

 
 

The Ghost of Enrollments Future

As seen in Becker’s Hospital Review: Written by Allyson Schiff, VP of Operations for Newport Credentialing Solutions Last week, Newport Credentialing Solution’s Vice President of Operations, Allyson Schiff, shared with you the first of two holiday themed articles reminiscent of the holiday classic, A Christmas Carol. In her first article, The Ghost of Enrollments Past,… Read More

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

Last week, Newport Credentialing Solution’s Vice President of Operations, Allyson Schiff, shared with you the first of two holiday themed articles reminiscent of the holiday classic, A Christmas Carol. In her first article, The Ghost of Enrollments Past, Allyson took a look at some of the biggest and most common enrollment mistakes witnessed in 2015. In this second article, The Ghost of Enrollments Future, Allyson offers advice on how to avoid enrollment errors and provides tips for creating a more efficient and effective enrollment process in the new year.
 
 
As seen in Becker's Hospital ReviewDon’t be a Scrooge. Click here to read the full article, if you dare…

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

The Ghost of Enrollments Past

As seen in Becker’s Hospital Review: Written by Allyson Schiff, VP of Operations for Newport Credentialing Solutions To get you in the holiday spirit, Newport Credentialing Solution’s Vice President of Operations, Allyson Schiff, has recreated the holiday classic A Christmas Carol. In the first of two holiday themed articles, Allyson will focus on The Ghost… Read More

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

To get you in the holiday spirit, Newport Credentialing Solution’s Vice President of Operations, Allyson Schiff, has recreated the holiday classic A Christmas Carol. In the first of two holiday themed articles, Allyson will focus on The Ghost of Enrollments Past, which takes a look at some of the biggest and most common enrollment mistakes witnessed in 2015. Her second article, The Ghost of Enrollments Future, will offer advice on how to avoid past enrollment errors and provide tips for creating a more efficient and effective enrollment process in the New Year.
 
 
As seen in Becker's Hospital ReviewDon’t be a Scrooge. Click here to read the full article…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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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.
 
 

Provider Enrollment Case Study

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

Increased Revenue Through Pro-Active Provider Enrollment

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

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

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

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

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

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

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

 

About the Author

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

About Newport Credentialing Solutions

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

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

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Cooper University Health Care

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

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

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

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

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

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

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

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

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

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

Outcomes:Significantly reduced credentialing edits driving increased revenue

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

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

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Are You Sure You Are Capturing Every Collectable Credentialing Dollar?

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

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

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

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

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

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

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

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

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