The topic we’re gonna discuss today is going to help you really get set up to have a- as efficient as possible credentialing and enrollment as you’re going through that pro- that process.
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Hello, and thank you for joining me today for another segment to discuss important and exciting topics on credentialing and enrollment. Before I jump in, I want to introduce myself. My name is Brandy Brimhall, and I am with Rapid Credentialing. I have spent the past almost 30 years in the world of healthcare and have found a passion in credentialing and enrollment, and really everything to do with the revenue cycle system.
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As we jump into the topic today, I wanna first share with you that it doesn’t matter the specialty you’re coming from, chiropractic, acupuncture, physical therapy, behavior health, and the list goes on. The topic we’re gonna discuss today is going to help you really get set up to have a- as efficient as possible credentialing and enrollment as you’re going through that pro- that process.
We’re gonna be discussing the best practices to implement and streamline for your credentialing and enrollment. If we could go ahead and go to the slides, I’ll get started. Again, like I mentioned, we’re gonna be discussing your best practices to implement for streamlining your credentialing and enrollment.
I am with Rapid Credentialing, and I’ll provide my contact information to you at the end of this segment. A few common things that I think is important for every single provider and every single business in healthcare to keep in mind as you’re getting started with credentialing and enrollment. Really, the first one is that, as I’ve mentioned before, credentialing and enrollment is part of the foundation of a healthy and sound revenue cycle system.
To be able to move forward as effectively and efficiently as possible, there are some tips and information pieces that I would like to share with you so you really know how to get teed up properly for credentialing and enrollment, and then move through, through those processes as manageably as possible.
As we get started just to help you get started and know where you need to start on the runway for credentialing and enrollment it is needed for any business and provider that’s expected to access in-network and sometimes even your out-of-network benefits with your third-party payers. This applies to you if you’re a new business or new entity, if you have a new location under an existing entity that’s already enrolled at a primary location, if you’re a new provider being added to an existing business.
Even if you’re enrolled from prior employment, your credentials need updated or corrected to your existing or your new place of employment. Also, any changes in your business structure, your business name, business ownership, all of those things will warrant some updates, corrections with your existing credentials and enrollments.
And then, of course, any changes in your region that bring in new plans or new payers, which happens all the time, this also would prompt potentially some updates, changes, or some new enrollments for your business. As you get started, if any of those bullet points are relatable to you, you’re probably going to need to look into to your credentials and make sure that you’re properly updated and enrolled The next thing you need to do is really know where you stand and what you need as far as credentialing and enrollment.
This means you need to conver- confirm the business entity enrollment, so the, the business that you’re working in, what enrollments do they have for the business group, as well as the individual provider enrollments that may be related to that business as well. Payers handle these differently based upon their own policies and for different specialties.
What I mean by that is some specialties, UnitedHealthcare, won’t enroll the business group. They’ll only enroll the b- the individual providers and link them to the tax ID. Varying payers have their own processes, and it’s important for you to know that not just for credentialing and enrollment purposes, but certainly for billing purposes as well.
The next thing you need to do is make sure you have good communication and clarify with your billing personnel, be it an in-house or outsourced billing service, to identify things such as any payers that process your out-of-network claims different from what you expect. In other words, if you think you’re in-network but you have claims under certain plans processing out-of-network, this is information you need to have because it’s going to make a difference on what steps you take for credentialing and enrollment.
You can also communicate on any plans that process out-of-network different from your understanding or expectation. In other words, if you think, “I’m in-network with Aetna,” or, “I’m in-network with Medicare Advantage,” but these claims are processing out-of-network, that’s a good indicator to you that you might need to do some evaluation and take some next steps in order to correct or update your credentialing.
The best place to gather this information, of course, is going to be with your biller, billing, or billing team. Next any providers in your business whose claims may be processing differently than other providers. We have this a lot at Rapid Credentialing, where we have some providers that are enrolled and contracted, others that somehow that slipped through the cracks and it wasn’t done, and those providers’ claims are processing out-of-network, and they’re processing differently, of course, than other providers in the business.
This, as you might imagine, is disruptive to billing, to patient communications, and to patient collections. All of these bits of information are accessible certainly by contacting the payers themselves, but your billers are usually a great, very quick source to give you that type of information. If you’re listening to me discuss this slide and you’re thinking, “Oh, my gosh, how am I gonna figure that out?
That’s too much work, too much time. I don’t have time,” one of the things that we do very frequently at Rapid Credentialing is what we call discovery, and that’s where we will go through and collect all of this information on your behalf for your business, for your providers, right down to effective dates, the plans and products that you’re enrolled with, and provide that information to you so you can have a snapshot of what’s ta- taking place right now and be able to make an educated decision on what you might need moving forward.
In either case, you need to make sure you know where you stand and what you… in order to determine what you need moving forward The next thing with credentialing enrollment as you’re preparing is really just discussing the proactive versus reactive approach. Keep in mind that credentialing, like I mentioned, is the foundation or part of the foundation of your revenue cycle system.
This means that credentialing is part of compliance as well. We’re not gonna discuss all of the compliance components other than to remind you, of course, we all want to be in the best posit- position to get paid properly for what we’re doing, to be able to combat denials and conduct appeals, and to be able to keep the money that you have been paid.
So to get started promptly, you want to make sure that if you are hiring a new provider or if you’ve just been hired, one of your very next steps is to look into what your specific needs are for credentialing yourself or that provider. You also want to make sure that you confirm the locations if you are moving into a new location, you’ve established a new business.
Once you have business information established, this is now the time where you want to get started with enrollment. Credentialing and enrollment is not submitted today, it’s approved tomorrow. It’s a process, and it needs a runway. You always want to make sure that you’re thinking downstream, if you will, in order to minimize disruption.
This means disruption in verifications, information on your verification of benefits that’s confusing or doesn’t make sense to you. Patient communications, we don’t know if we’re in-network or out-of-network. Of course, what to collect and how to collect over-the-counter from your patients, and then, of course, the impact we know to claims submission, billing, and aging accounts receivable.
So as you think about the credentialing and enrollment, look at it as though it’s at the very top of the stream in your business and your revenue cycle system. As you’re planning and preparing to add a new location, open a new business, add a new provider, think about those downstream impacts and where interferences can cause disruption in patient relationships and your revenue cycle system as a whole.
So we want to make sure to address everything that we possibly can at the top of the stream as it relates to credentialing and enrollment. We’re going through those particular steps right now in this segment to help you really start off as efficient and prepared as possible. The next thing you want to do with credentialing and enrollment is make sure that you have realistic expectations.
Credentialing and enrollment, like I mentioned already, needs a runway. It’s not submitted today, it’s approved tomorrow. For brand-new enrollments, payers will tell you to allow 120 to 180 days for new enrollments. They’ll tell you to allow 45 to 120 days for existing enrollment corrections and changes.
Of course, this is going to vary by payer, as well as what’s being done with those existing enrollments. And so allow a runway because that’s gonna put you in the best position to be as prepared as possible For all of the rest of the downstream activities that take place with our revenue cycle system.
Before I conclude today, I want to leave you with just a few tips for success. The first one, as we all know, with anything related to business, communication is key. This means with your credentialing team, with your front office and reception team, certainly with your billing team. One of the challenges that we have at Rapid Credentialing is not being able to collect the information from the providers in a timely manner in order to prepare and submit clean and complete applications.
If you’re working with our team, one of the first things we ask is to help us help you. In other words, we send to you a welcome email with a checklist of the documents and data that we need in order to prepare and submit clean and complete applications. That’s what’s going to enable you the fastest pathway to approval with a…
Excuse me, with any payer. With that being said, if you’re working with my team, as efficient, efficiently as you possibly can, please make sure you provide us the accesses, the data, and the documents so that we’re able to move your applications through as quickly as we can. Another question that I commonly get with third-party, or with third-party providers or businesses is we’re adding new doctors to our business, and we don’t want to put the investment in.
Credentialing comes with a time expense and often a financial expense, and we don’t want to pay that, or we’re not sure we want to pay that at this time, because what if our providers leave? A pr- a common recommendation is to implement into your provider agreements some type of agreement that simply just says that the business is perhaps paying for the credentialing and enrollment if that’s what you choose to do.
However, if the provider leaves in less time than, say, two years or 18 months, ultimately whatever you decide, then that provider is responsible for reimbursing to your business all or a portion of the credentialing expense that you have absorbed on their behalf. So that’s one of the common recommendations I make with providers to to help them move forward with credentialing and not delay implementing credentialing and enrollment processes as it’s required for other providers joining their business.
As we go ahead and conclude, again, as a reminder, this topic and the details that we’ve discussed today are really relatable to any specialty and any provider type to help you set up for success with credentialing and enrollment. Thank you so much for joining me. If you have any questions at all, my contact information was shared on the screen there in email and by phone.
We look forward to hearing from you. Thank you again for joining me.