Thought Leadership

New Perspectives To Improve the Credentialing Industry

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 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!

Newport Credentialing