Thought Leadership

New Perspectives To Improve the Credentialing Industry

Category: Revenue Cycle

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.
 
 

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.
 
 

RCM Tip of the Day: Curtail Tax ID Numbers

As seen in Becker’s Hospital CFO Report: Written by Kelly Gooch Hospitals and health systems should limit the number of tax ID numbers per provider to streamline claims processing delays and prevent lost revenue, says Patrick Doyle, senior vice president at Newport Credentialing Solutions. Mr. Doyle shared the following tip with Becker’s Hospital Review. “When… Read More

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

Hospitals and health systems should limit the number of tax ID numbers per provider to streamline claims processing delays and prevent lost revenue, says Patrick Doyle, senior vice president at Newport Credentialing Solutions.

Mr. Doyle shared the following tip with Becker’s Hospital Review.

“When not managed properly it’s easy to lose control over the number of tax IDs your providers have; this is especially true for large hospitals with hundreds of providers. A good rule of thumb is no more than three tax IDs per provider. While downsizing these numbers is a cumbersome task that requires diligent follow-through, an outsourced partner with proven knowledge and resources can make a world of difference in regaining control.”
 
 
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Becker’s Hospital CFO Report is the original producer of this publication.
 
 

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.

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!

 
 
 
 

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.
 
 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Download

Click here to download the PDF.

 

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 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!
 
 

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

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

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

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

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

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

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!

 
 

Credentialing Implications on Patient Satisfaction

With the advent of Accountable Care Organizations (ACO’s) and population health management initiatives, healthcare organizations are implementing technology and process solutions designed 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… Read More

With the advent of Accountable Care Organizations (ACO’s) and population health management initiatives, healthcare organizations are implementing technology and process solutions designed 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 effort to enhance patient satisfaction scores, they are all too often burdened by events that occur outside the scope of treatment. Parking convenience, patient wait times, and the perception of a courteous medical staff all impact the patient’s experience and the way they express their level of satisfaction. One often overlooked scenario impacting patient satisfaction is the credentialing and enrollment status of a provider that is assumed – both by provider and patient – to be in a payer’s network.

When a provider’s participation status with a health plan is disrupted – which could stem from a failure to adequately monitor expiring documents, errors in the initial/ re-enrollment process, or failing to identify all locations where that provider will see patients – the patient may face a denied claim for utilizing “out-of-network” services or be told by their health plan that they are responsible to pay higher co-insurance levels than previously disclosed. Since the patient is generally held harmless in these scenarios, most providers will quickly work with the patient and write-off these charges. However, the patient’s experience in these instances is generally unfavorable regardless of the financial outcome or impact they ultimately realize.

What compounds the problem in this scenario is the failure to record the root cause of a patient’s dissatisfaction. Unless a patient takes time to write a narrative describing this scenario, most survey forms will not specifically address credentialing related issues and the patient’s dissatisfaction can manifest in other metrics that are monitored. This leaves the organization with a skewed data set of unfavorable survey outcomes and an inability to take appropriate corrective actions.
 

About the Author

Patrick Doyle is the Vice President of Business Development for Newport Credentialing and has over 20 years of experience in healthcare IT and revenue cycle solutions.

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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University of Pennsylvania Health System – Academic Medical Center

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

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

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

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

Highly experienced staff provides necessary resources

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

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

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

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

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

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AtlantiCare – Hospital Employed Physicians

AtlantiCare Physician Group (APG) provides high-quality, convenient healthcare to communities throughout southern New Jersey. With more than 350 physicians, APG offers a full range of outpatient health services including urgent care, primary care, specialty care and occupational health. This large and growing practice has more than 80 different billing areas comprised of primary care, group practices,… Read More

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

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

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

Streamlining processes through automation

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

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

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

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

Improved communication and a close working relationship

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

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

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

Highly experienced staff and proven processes maximize revenue

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

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

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1DocWay – Independent Physicians

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


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

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

Proven Processes and Highly Experienced Credentialing Staff

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

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

Simplifying the Credentialing Process

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

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

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

Maximizing Revenue

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

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

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Credentialing Challenges and Opportunities for Independent Physicians

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

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

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

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

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

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

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

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

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

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Credentialing Challenges and Opportunities for Physician Practices

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

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

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

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

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

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

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

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

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

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FOX Rehabilitation – Non-Physician Providers

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

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

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

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

A Collaborative Effort Helps Streamline Processes

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

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

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

Expert Staff Eliminate Resource Constraints, Save Money

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

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

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

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