13 Aug Keeping Up with Credentialing
When reviewing (or developing) your revenue cycle management plan, don’t overlook the first steps: making sure all your providers are appropriately credentialed with all your payers and associated products. Credentialing and Provider Enrollment are more than just arduous tasks of paperwork; without them, claims aren’t paid and revenue suffers. Opportunities to grow your practice and strengthen your revenue depend on a solid credentialing and contracting game plan.
Key functions that help your practice receive proper reimbursement from insurers:
- Payer Product Analysis: Most insurers offer multiple products and these products can change annually, especially Medicare Advantage, Medicaid HMO, and ACA plans. Review your agreement with each payer so you know which products are included. Changes to the covered products can be requested.
- Payer Participation (Par vs. Non-Par) Analysis: Verify that all of your providers are participating, “in-network” providers with your contracted payers (and each product for a particular payer). If you have multiple practice locations, verify each location is linked and that your providers are also linked to each respective location.
- Payer Re-Credentialing: CAQH profile update and re-attestation; Medicare/Medicaid Revalidation; Timely completion of re-credentialing applications. Let any of these slip through the crack for your providers and you run the risk of having their participating status revoked and claims denied.
- Onboarding New Providers: When adding a new provider to your organization, get a jump on this to avoid a severe lag in collections. While most insurers only allow you to start enrollment 60 days prior to an effective/start date, some insurers will allow you to begin enrollment 90 days prior to the start date. That means starting to gather data and preparing applications 120 days before the start date.
Implementing best practices for provider onboarding to reduce your DIE (Days in Enrollment) and expanding your payer network to minimize out-of-network denials will help streamline your operations and make you more efficient, productive, and profitable.
Expertise Matters
Proper credentialing is the key to unlocking the revenue your pediatric practice needs to thrive and continue providing high-quality care for children. Credentialing and enrollments can be complicated, but they don’t have to be. When you work with a company that provides end-to-end services, it ensures accurate applications, prevents costly deactivations, and eases the administrative burden on your practice. Benefits include:
- Shortening payer application timelines
- Getting reimbursed faster
- Maintaining compliance and up-to-date provider credentials
- Eliminating costly errors
- Expanding access to care
- Improving the quality of care
Consider simplifying the credentialing and enrollment process so you can focus your time on other important tasks.
