nextgen-healthcare-flyer-rcm-credentialing-checklistCredentialing should be viewed as an integral part of the revenue cycle because if you are not enrolled correctly, you will not be paid correctly. Trends show that The Affordable Care Act (ACA) and the evolution of Accountable Care Organizations (ACOs) is influencing hospitals to align themselves with provider groups at unprecedented rates. As a result, increased provider onboarding volumes are overwhelming existing credentialing staff at many practices. One provider can spend 40+ hours dealing with enrollment. Often there is just one staff member designated to manage credentialing and this can lead to a lack of focus on credentialing which directly effects: higher A/R days, increased denials, non-par payments, customer service issues, and frustrated providers.  All of which affects a practice’s revenue and cash flow.

Five tips to ensure credentialing isn’t draining your time or money

  1. Review all applications and contracts prior to submission to the carriers to ensure all information is accurate and up to date – this will help avoid errors in the health plan databases.
  2. Manage credentialing by being aware of health plan re-credentialing timelines – including CAQH – so you can ensure no provider has a lapse in participation.
  3. Only Medicare allows retroactive effective dates to be awarded (up to 30 days prior to the date they receive the application).
  4. Maintain a scheduled approach to follow up during all application processes – health plans can take over six months to enroll a provider at times, but there may be additional information needed to complete enrollment, and constant thorough follow-up is the best way to ensure the application is consistently being worked.
  5. Manage your providers Days In Enrollment – keeping track of an average of how long the health plans are taking to enroll a provider can be a good key indicator for how early you want to submit enrollment applications.

To learn more about preventing credentialing denials from affecting revenue watch a recorded webinar on the topic today!

Outsourcing practice credentialing can have huge benefits

Administrators looking for ways to reduce financial burdens, improve outcomes, and eliminate waste—without sacrificing quality of care—are turning to outside partners for help. By partnering with an organization that specializes in managing the entire credentialing lifecycle through the use of cloud-based workflow software, advanced cloud-based reporting and analytics coupled with industry defining domain expertise, administrators are successfully controlling the time and costs associated with credentialing.

Five benefits of outsourcing credentialing

  1. Reduce errors
  2. Save money
  3. Gain efficiency
  4. Expedite processing
  5. Store data safely

You may benefit from taking a closer look at how credentialing is impacting your practice—and weigh the tradeoffs of handling processes in-house vs. outsourcing.

Download our Credentialing Checklist to see if outsourced credentialing is right for your practice.