Credentialing and enrollment involve a myriad of data requirements and strict deadlines, leaving little room for error. Mistakes can cause reimbursement to be delayed or denied altogether. Ongoing demands of maintaining an up-to-date credentialing and enrollment process requires considerable resources. Often, forms are completed manually or by using outdated software systems that are not interoperable. Fortunately, you can take steps to improve the efficiency of your credentialing and enrollment process to maximize care delivery and revenue cycles.
Be prepared — Begin planning a few months in advance, especially if new physicians will be joining the practice. Many practices include a request for credentialing information alongside an offer of employment letter. If physicians do not submit documents in a timely fashion, consider making their start date or initial pay contingent upon providing all required paperwork.
Employ best practices — Fill out all required form fields; leaving anything blank will likely cause delays. Coordinate workflows as efficiently as possible. If delivering documents to a notary public has become a hassle, keep the process in-house by paying some of your staff to become notaries. Monitor workflows so that modifications can be made as soon as problems arise.
Maintain ethical billing protocols — Some practices have bought into the myth that, while awaiting credentialing, it’s acceptable to bill under another physician’s identification. This is especially problematic if an adverse event occurs, or payers specifically prohibit the practice. Instead, payers usually encourage you to use a Q6 modifier, billing the new practitioner as a locum tenens. It’s best to strictly adhere to payer policies and evaluate your record of denials and adjustments related to credentialing.
Work as a team — All departments involved in credentialing and enrollment need to collaborate to make the process as effective as possible.
Technology is Key
Much of the backlog that typically occurs in credentialing and privileging can be avoided with enhanced technology solutions. Advanced software facilitates best practices, reducing the amount of time it takes to onboard a practitioner.
Use cloud-based technology — The cloud allows practices to manage data via an enterprise-wide platform in real-time, eliminating the inconvenience and limitations of client-server systems that many entities still utilize.
Standardize processes around enterprise-wide technology — Using superior software allows practices to streamline tasks and establish key indicators to regularly measure performance. Integrated systems and user-friendly features eliminate redundant data entry and allow staff to readily analyze information. Competent customer support minimizes workflow interruptions.
Verify physician information — If the information provided by the practice doesn’t match what the payer has on file, denials or delays will likely result. Advanced technology makes it easier to verify that information submitted to payers is accurate. Data entry errors are less likely. When they occur, they can be corrected without the tedium of completing paperwork by hand.
Consider how technology reduces lost revenue — According to Becker’s Hospital Review, a survey of healthcare industry leaders revealed that, in two-thirds of cases, it takes longer than five or six weeks to privilege a physician. An integrated technology platform drastically reduces turnaround time by allowing staff to access data at any time, from any location, and share it with payers.
An inefficient credentialing and enrollment process can lead to millions of dollars in lost revenue each year. High-quality software allows for automated workflows and well-organized, easily-accessible data that enhance payment outcomes. The New England Journal of Medicine reported in 2012 that a national, well-coordinated credentialing and enrollment system would save providers nearly $1 billion annually in administrative costs. While such a system hasn’t yet been implemented, the technology is available to keep administrative costs manageable while optimizing payer reimbursements.