The reimbursement shift from “fee-for-service” to “fee-for-value” has many healthcare organizations focusing on population health management. However, a large number of practices are not equipped to handle the complexities of the provider credentialing and enrollment processes in this new payment model. The process itself can be messy with lots of redundant tasks and information to forage through and assemble. A lot of the same data has to be reviewed by a lot of different people. Among the financial repercussions a practice faces for not enrolling providers with their payers correctly is lost revenue. Conversely, when organizations implement the right provider enrollment strategy, they can better capture every dollar.

Here are a few recommended best practice steps a practice can take to optimize credentialing results:

  • Follow up during all application processes and don’t assume that once you submit it everything is on track. Because credentialing and provider enrollment delays will happen, it is important to monitor the process each step of the way.
  • Manually monitoring this process can be very complex and time-consuming, so use automated reports that offer a real-time snapshot of what’s going on. Track days in enrollment, denials due to credentialing, and highest dollar volumes effected by payer.
  • The most common mistake associated with credentialing is a lack of attention to detail. To prevent important tasks from falling through the cracks, all your provider applications should go through a rigorous review process to certify accuracy before it is submitted.
  • Demographic and primary source documentation should be housed in a central repository and available for review, as needed. There are benefits to utilizing a cloud-based credentialing workflow for such purposes.
  • Because enrollments can take 90 to 120 days, ensure you allow for enough planning time.

To help practices capture every collectible dollar, provider enrollment must be an integral part of the revenue cycle. If not, healthcare organizations may not be paid correctly. What’s more, they may face compliance violations or false claim liability for improperly or poorly managed credentialing and enrollment processes.

Keep costs down and ensure a healthier bottom line. For more, download our RCM credentialing eBook.