Your practice’s revenue cycle management is the process of collecting, tracking, and reporting on your payments from patients and payers. If you’re not collecting 100 percent of your revenue, it’s not only costing you money—it’s also hurting your reputation with patients who may decide to go elsewhere when they have a choice. Even worse, failing to collect all of the money due to your practice can result in penalties and potential legal action if one of your patients ends up having trouble paying for something.

Many practices make the mistake of assuming that if they collect patient-pay and insurance payments prior to a procedure, they will have no remaining receivables. But a successful practice must look at the following three key factors to implementing a successful revenue cycle management process:

To manage the revenue cycle more effectively, there are three key factors to keep in mind:

• Revenue management
• Eliminating A/R
• A/R management

Revenue Management

Revenue management is the process of managing the amount of money that a business receives from customers. it’s important that you know how a practice’s revenue management works and how it affects the patient’s access to care.

Eliminating A/R

A/R management is an important aspect of your practice that helps you collect your accounts receivable. Effective A/R management can significantly improve the cash flow in your practice.

While many practices focus their time and effort on bringing in new referrals, it is equally important to spend some time managing the accounts receivable process so that all of your hard work will be rewarded.

A/R management

A/R management is an important part of running a practice. If you are not collecting your revenue, then you will have problems paying your bills. The first thing that you need to do is understand why the A/R is not being collected. It could be because of any number of reasons such as:

• The patient does not have the money to pay
• Your invoices sent out are too complicated or confusing
• You haven’t been sending out reminders when they were due.

To address these problems and get those claims paid, there are some steps that you can take:

1.  Keep track of all unpaid claims so that they don’t get lost among other papers in your office – this will help prevent late payments from happening again. 

2. Be sure that anyone working on billing understands how important it is for them to send out claims about upcoming deadlines for payment before time runs out for collection purposes; otherwise, there won’t be anything left in their accounts at all! Remember also never let any items go past 180 days without sending out reminders–this usually results in more debt collectors coming after us later down the road which costs more money than simply doing things correctly upfront.”

The best way to ensure you are collecting every cent of your revenue is by using an efficient and effective revenue cycle management solution.

When it comes to revenue cycle management, there’s no such thing as “good enough.” The best way to ensure you are collecting every cent of your revenue is by using an efficient and effective revenue cycle management solution.

A good quality revenue cycle management system will help you:

• Automate processes in order to house more patients and increase revenues
• Reduce expenses and increase patient satisfaction through better communications between the front desk, doctor offices, and back office staff
• Improve productivity by streamlining workflows across multiple locations

Conclusion

The key to successful revenue cycle management is understanding the three factors of revenue management, eliminating accounts receivable, and A/R management. These are all critical processes that must be in place in order for any practice or business to maximize the potential of its collections and stay profitable.

We’ve talked before about what revenue cycle management is and why it’s important, but you may still be wondering what a successful revenue cycle looks like. What are the components that make up a revenue cycle and how do they come together to produce success? Let’s take a look at each essential component of the cycle and how they work together to drive your healthcare facility’s overall financial performance.

Chargemaster

Chargemaster is the electronic database used by healthcare providers to determine the prices of procedures and services. It’s also sometimes referred to as a rate card or fee schedule. Chargemasters are created by hospitals, clinics and other providers to determine how much they will charge for their services. The data in these chargemasters change periodically to reflect changes in the cost of providing care or upgrading equipment.

Pricing

No matter how good you are at providing excellent care, if your office is not set up to collect money, your revenue cycle will suffer.

To be successful in managing the revenue cycle, it’s essential that you understand how pricing plays a role in your success—and what you can do to ensure that patients pay for their treatments.

Pricing is an essential component of revenue cycle success because it helps determine payment amounts for services. In fact, pricing is so important that many healthcare providers spend years developing their own complex systems and algorithms to determine fair prices for each procedure or treatment they offer patients.

Revenue Capture/Control

Revenue control and revenue capture are two sides of the same coin. Both refer to the process of managing revenue, which is one of the key components of a successful revenue cycle. If you want to create a successful revenue cycle, it’s crucial that you understand how these terms fit together and how they differ from each other.

Revenue control refers specifically to what happens once a customer has paid for their product or service—that is, it refers to ensuring that customers pay their bills on time and in full. Revenue capture refers more broadly to ensuring that all payments are collected at all times, including when they come from sources other than customers (such as claims against insurance companies).

Registration/Scheduling

Registration and scheduling is the initial step in the revenue cycle. It involves registering new patients, scheduling appointments and reminding patients of upcoming appointments. You’ll also need to be able to reschedule or cancel appointments as needed.

Successful revenue cycle management requires a system that can manage all of these steps with ease, so you can focus on providing your services and collecting payments from your patients instead of dealing with the logistics of running an office.

Coding

Coding is a key element of revenue cycle management. It is used to track and report on claims, which helps ensure compliance with federal and state regulations. It also ensures that your patients are properly reimbursed for their care at the time of service.

In sum, coding plays an important role in helping you manage your revenue cycle, as well as ensuring compliance and reimbursement for your patients’ care.

Business Office

The Business Office is the link between patient care and revenue generation. That means they’re responsible for managing billing, collections and accounts receivable. They work with patients on questions or concerns about their bills as well.

Customer Service

The best way to ensure that your revenue cycle is running smoothly is to provide customer service that is consistent with the brand and is delivered in a timely manner.

Customer service that provides solutions for customers in a timely manner will help you achieve better ROI on all aspects of your revenue cycle. Your goal should be to deliver solutions as quickly as possible, preferably within 24 hours, so you can avoid the “no-purchase” decision from happening at all. This means responding quickly and accurately when someone has an issue or question regarding their product or service purchase.

Successful revenue cycles are based on strong foundational components that support each other and contribute to the success

To achieve a successful revenue cycle, it is important to understand that different components of your revenue cycle work together and support each other. You can’t have one without another; they are all necessary for success. Strong foundational components like Chargemaster, Pricing, Revenue Capture/Control and Registration/Scheduling are essential in achieving great results.

The first step in building a successful revenue cycle is to establish a solid foundation: the Chargemaster. This document is an itemized list of all medical supply products and services provided by your organization with associated costs per unit or service rendered along with any discounts or allowances for specific groups such as Medicare or Medicaid patients based on reimbursement rates from third-party payers (insurers).

Conclusion

In short, a robust revenue cycle helps to ensure that your organization can continue to provide quality care for patients by covering the costs of operating successfully. A successful revenue cycle is built upon a foundation of strong individual components that work together to promote accurate and timely billing. And, having visibility into these foundational aspects allows you to see how they are performing as a whole, so you can make adjustments or even discover new process improvements that will ultimately lead to increased reimbursement and patient satisfaction.

    Start Your Facility / Practice’s Journey To Success With WWS.

How to Plan Your Revenue Cycle Process: A Beginners Guide

‍The revenue cycle is an important process within healthcare organizations. It helps administrators manage patient check-in, billing, insurance verification, clinical documentation, and other processes that are essential to maintaining financial health while also providing care. If you’re just beginning your journey as a hospital administrator or hoping to take on more responsibilities in your current position, you might be wondering how you can plan the revenue cycle for your healthcare organization. The good news is it isn’t very difficult! In this blog post you will learn about the various processes that are part of the revenue cycle as well as how you can plan yours from start to finish. Keep reading to discover everything you need to know about planning your revenue cycle as an administrator!

 What is the Healthcare Organization’s Revenue Cycle?

The healthcare organization’s revenue cycle refers to the collection of processes that bring in revenue. The term is generally used in relation to hospitals, but it might also apply to other types of healthcare organizations. These processes include registration and billing. The revenue cycle has three stages: Registration – This is when patients arrive at the hospital and are prepared to be treated. Registration includes checking in, consenting to treatment, and providing information about insurance coverage. Billing – This is when the hospital bills insurance companies and patients for their treatment. Collections – This is when the hospital collects payment for the services provided. When patients pay for their own treatment, the revenue cycle is slightly different. In this case, the revenue cycle includes only two stages: billing and collections.

 Identifying the Stages of your Revenue Cycle

The first step in planning your revenue cycle is identifying the steps in your current process. You can do this by conducting a review of current policies and procedures. Conducting a thorough process analysis can help you identify where the areas of opportunity are within your revenue cycle. You can also take a look at other organizations’ revenue cycles to gain more insight into the various stages of your own revenue cycle process. Hiring a consultant such as WWS to review your system can also be helpful.

 Step 1: Define your current process

Before you can begin to change and improve your revenue cycle process, you must first understand the exact steps involved. To start, collect data on your organization’s customers, including demographics, volume of services provided, actions taken, and payment options. Collect data on your financial situation and revenue cycles to get a better idea of where there might be opportunities for improvement. Analyze data to identify trends and patterns, such as the particular days of the week or times of the year when revenue is the highest or lowest. Next, break the revenue cycle process into stages. You might break it down into registration, billing, and collections or include other stages such as insurance verification.

 Step 2: Benchmark against peers and competitors

With an understanding of the current state of your revenue cycle process, you can then compare it against your competitors and peers in the industry. By doing so, you can identify areas where your organization is performing well and those where improvements could be made. For example, if your peer hospitals are seeing an average payment of 90 days while your organization is experiencing an average payment of 120 days, you know that your process could be improved.

Step 3: Determine where you are losing money

By taking a close look at your current revenue cycle process, you can evaluate where it may be costing you money. For example, if clinical documentation is taking longer than it should be, or if billing is taking a long time to be completed due to bottlenecks in the system, you might be losing money. You can also evaluate your workflow and checklists to determine whether they are efficient or if they are causing bottlenecks and delays in your organization.

Step 4: Identify where you can save money

After determining where your revenue cycle process could be costing you money, you can now evaluate where you can save money. For example, if your documents are being sent to a transcription company instead of being transcribed in-house, you can save money by bringing transcription back in-house. You can also take a look at your software programs and their capabilities to determine whether there are ways in which they can be optimized to save you money.

 Step 5: Plan for these changes

After you’ve identified potential changes to the revenue cycle process, it’s time to plan for those changes. Planning for change is essential as it allows you to take a step back from the immediate pressures and demands of your daily job and allows you to take a strategic approach to improving your revenue cycle process. Planning for change involves understanding the change, creating a timeline, and assigning the right resources to the task. Planning for change allows you to create a budget for the necessary changes and gives you the time necessary to complete the work correctly.

CONCLUSION

The revenue cycle is an important and complicated process within healthcare organizations. It helps administrators manage patient check-in, billing, insurance verification, clinical documentation, and other processes that are essential to maintaining financial health while also providing care. It’s important to understand that while the revenue cycle process is important to your organization, it is constantly changing. As an administrator, it is your job to keep up with these changes and ensure that your organization is always operating as efficiently as possible. If you’re just beginning your journey as a hospital administrator or hoping to take on more responsibilities in your current position, That said you are not alone Hiring an expert team such as WWS to your medical specialty makes sense when you’re looking for help with your Revenue Cycle Management Requirements. Our extensive list of clientele demonstrates our successful track record with different specialties. A niche service, our competencies helps you in improving your revenue right away.

The refusal of an insurance company or carrier to honor a request by an individual or his or her provider to pay for health care services obtained from a healthcare professional is referred to as claim denial. Many practices do not bother to file an appeal when their claims are denied. According to the American Medical Association, the most common reason is that providers do not believe they will recoup enough from appeals to justify the administrative costs that a denial management process will impose on the practice. All that was required of the practice was an audit and an appeal of the denials.

NUMBERS OF DENIALS

• The average cost of reworking a claim is $25.00, according to the Healthcare Financial Management Association (HFMA).
• Payers deny 15 to 20% of all claims submitted in terms of gross charges.
• 65 percent of claim denials are never worked, resulting in a 3% loss of net revenue.
• Approximately 67% of all denials are appealable.

TYPE OF DENIAL

Soft Denial:

• A temporary or interim denial that may be paid if the provider takes effective follow-up action.
• Medical records are still being received.
• Denied because of missing or incorrect information
• Coding or billing issues
• Pending itemized bill Pending invoice receipt

Hard Denial:

• A denial that causes revenue to be lost or written off.
• Pre-approval is not required.
• This is not a covered service.
• Bundling
• Inadequate filing

Preventable/Avoidable Denials: 

• A firm denial caused by action or inaction on the part of the service provider. It accounts for roughly 90% of denial.
• Inaccuracies in registration
• Ineligible Insurance
• Invalid Coding 
• A medical necessity 
• Credentialing issues 

TOP REASON CODES FOR CLAIMS ADJUSTMENT

• 16: Claim is missing information or contains billing/submission errors.
• 96: Non-covered expense (s)
• 204: The patient’s current benefit plan does not cover this service/equipment/drug.
• 197: There is no precertification/authorization/notification.

STRATEGY OF ZERO TOLERANCE WITH YOUR DENIALS 

Create a Zero Tolerance policy for denials that are preventable or avoidable. Process improvement efforts should concentrate on breakdowns in denials prevention processes such as patient information and insurance verification, inaccurate or missing documentation, and communication issues. Ensure that all employees are familiar with the terms of the payer contract. Non-emergency services should be scheduled at least a day in advance to allow for prior authorization.

If you have been denied Claims Management in your medical billing department or are not getting satisfactory results, contact WWS directly at +1(302)613-1356 to learn how we can assist you.

Charge Entry process is a critical step in the Medical Billing Cycle; it is critical that this scope of services is handled by experts who are up to date on the payor fee schedule for the service rendered. For increased reimbursement, the charge entry process should be an essential part of daily billing. Let’s talk about how to Optimize Charge Entry to achieve your financial goals.

Potential Pitfalls in the Charge Entry Process

Processing Fee Entry without errors or mistakes is a challenge for any billing team because even a typo or inadvertent miss can result in significant financial loss. Billers are frequently unaware of insurance policy changes and updates; being unaware of fee value changes and continuing to bill for old charges results in revenue loss.

Obtaining Quality in Charge The entry process is only possible if the following steps are followed correctly:

• Documentation of the physician’s treatment that is clear and complete. All billable services must be documented in the medical report by the physician in order for billers and coders to enter appropriate Medical Codes and Charges to be claimed from the payor.
• To meet internal quality standards, eliminate likely data entry errors and mistakes.
• Allocate a trained and experienced team to handle major services such as charge entry.
• Keep an eye out for policy updates or changes to the fee schedule from the Centers for Medicare and Medicaid Services (CMS).
• Allow a dedicated audit team to audit a portion of daily workflow to ensure quality and compliance standards are met. In addition, any repeated errors or flaws in process flows must be captured and reported.

With a Medical Billing expert handling complete Revenue Cycle Management Services optimizing Charge Entry or other scopes of services, all parties involved can achieve maximum reimbursement and financial growth.

About WWS

WWS is one of the leading Offshore Medical Billing Companies in India, promising to avoid claim rejections and denials with our expertise and experience. With decades of experience in Medical Billing and Revenue Cycle Management Services, our team guarantees maximum monthly collection through an optimized Charge Entry process.

Benefits of Outsourcing Charge Entry Process

Outsourcing charge entry to a third-party Medical Billing Company results in improved quality and a higher reimbursement percentage. A few advantages of Offshore Outsourcing Charge entry and other RCM scopes are listed below.

Avoid time lags because the offshore crew is available 24 hours a day, 7 days a week, and handles the majority of the data entry work during the night hours in the US, allowing for speedier claims processing. 

Regular audits aid in identifying areas that effect collection percentages and educating the charge entry team to be more careful. It also aids in the detection of errors in medical report documentation.

Remove from the equation Control and correct frequent denials that stem from the same source.

The law’s main premise is that a payer must reply to a valid claim within a certain amount of time (usually around 30 days for electronic claims).

In order to efficiently use the clean claim rule, your medical billing process must have a tracking system that flags:

• Which insurance firms are covered by your state’s clean claim statute (some are exempt)?
• The date on which your clinic submits each medical claim for the first time;
• Events that bring the clean claim clock to a halt (e.g., an information request from the payer),
• When your practice has responded to payer requests by taking action;
• The date on which you received the final adjudication decision from the payer.

The prospect of carefully tracking all of this data may seem intimidating, but with the right system architecture, it is both achievable and desirable. Your claims will pay faster after you file a few Clean Claim law violation reports. I’ve witnessed cases when payers have contacted solely to reassure the practitioner that claims will be processed swiftly.

Running a trial on a payer that frequently takes more than 30 days to adjudicate claims is one method to quickly get started using the clean claim law. Find a small number of significant claims for this payer that have been open for more than 30 days and run a test with them. This will enable you to understand the foundations of how to file, monitor, and view the results of complaints.

Tips for Getting Your Medical Practice to Have a 95% Clean Claims Rate

How can your medical practice attain a clean claims rate of 95%? Despite the fact that this may appear to be a tall goal, there are several medical billing tactics your medical practice may apply to help increase your clean claims rate – and your entire revenue cycle management!

Keep patient records up to date.

There’s a lot of patient information that can change—and change quickly—from contact information to insurance carriers and more. Patients must check or update their current information before getting treatment, as faulty patient data is a leading source of denied claims. To reduce delays, use exact documentation to help check patient information ahead of time, and have patients update their paperwork at every visit (or even sooner with automated reminders).

Prior to the date of service, double-check your eligibility.

Patients that come to your office on a regular basis are known as established patients. They’re also the patients who your employees might presume haven’t had any recent insurance changes. Most denied claims, however, are generally the result of outdated established patient insurance information. Collecting and confirming every patient’s primary, secondary, and even tertiary insurance at least five days before their scheduled service is one step toward a 95 percent clean claims rate.

It’s also vital to double-check any in- or out-of-network benefits, copays, or deductibles.

Keep in mind the deadlines for filing insurance claims.

In most cases, filing a claim necessitates submitting it within a specific time frame. Any claim submitted outside of the window will result in a higher number of refused claims.

 If you want your practice to have a near-perfect clean claim ratio, one of the best ways to do so is to pay attention to claim deadlines and handle any concerns with patient coverage prior to their date of service so the claim is not submitted late. Aim for authorization between three and five days prior to service as a best practice.

Even the cleanest, most well-documented claim can often take weeks, if not months, to process. In the meantime, the practice loses out on revenue. This is why many of them opt to have their billing handled by a third party. Ultimately, WWS contributes to a smooth, continuous flow of revenue that benefits the bottom line of health practices. Contact WWS today to learn more.

A streamlined and efficient financial process is crucial for any successful practice, and is a key to a healthy revenue cycle.

Take a look at these seven monthly revenue tips that will improve your financial process and ultimately free up more time to focus on what matters your patients.

1. Evaluate Accounts Receivable.

Did you know that approximately 15 percent of claims are never paid due to billing errors, and up to 50 percent of re-submitted claims are never paid?

You should be averaging less than 45 days in accounts receivable and striving for an ideal average of under 30.

2. Reduce Excessive Accounts Receivable

There are a number of things you can do trim accounts receivable excess.

Here are a few:

• Separate accounts receivables by insurance and patient balances.
• Separate the different insurance payer types, and understand how their payor specific guidelines affect your accounts receivable management.
• Identify key offending payers prioritized by amounts outstanding.
• View monthly reimbursement trends for each payer.

3. Improve Code Accuracy.

Code inaccuracy is a big time and energy waster.

You can improve accuracy by routinely scrubbing codes before submission.

4. Analyze Denied Claims.

One of the biggest issues that negatively affect revenue is denied claims.

In fact, according to the Government Accountability Office, up to one in four claims are denied. By analyzing your rejects and denials, you can identify patterns that can be corrected. Consider the following:

• Are insurers determining the care a patient received as medically unnecessary?
• Is beneficiaries receiving care outside their networks without realizing it?
• Are names spelled correctly?
• Are numbers consistently entered between two or more parties? If not, this can create a “data freeze.

5. Improve Your Verification Stage.

The claims reimbursement process begins as soon as a patient first makes an appointment with a physician’s office or healthcare provider.

6. Send Clean Claims.

It is crucial to send a clean claim the first time around.

Sure, it might take an extra 30 to 60 seconds per claim to thoroughly scrub it for initial submission. But if the claim is denied, it’ll end up taking an average of 15 minutes per claim.

7. Get Help. Hire a Chiropractic Billing Service.

Keeping up with all the normal, day-to-day tasks that go into running a successful chiropractic office isn’t easy.

Your staff must work diligently and methodically to review suspended claims and analyze where holes or gaps exist with things like compliance, errors and timeliness.

What Are Your Biggest Monthly Revenue Challenges?

Are you finding it difficult to streamline your financial process in order to increase revenue?

What are the most difficult challenges you face? Do you have any additional tips or strategies to share that have made a difference in your chiropractic office?

Many Chiropractors Are Not Aware of the Benefits of Outsourced Billing

When you look out into your office, the situation likely appears under control. We understand that you are good at what you do. Hiring an outsourced billing service can increase revenue, bandwidth, and quality of life for your entire team.

Have you considered the financial and bandwidth benefits of outsourcing your billing services?

Using resources available to you, like medical software and outsourced billing services, will increase your monthly revenue, streamline your financial process, and get you back to what matters helping your patients.

We help you earn more revenue with our quick and affordable services. Our customized Revenue Cycle Management (RCM) solutions allow physicians to attract additional revenue and reduce administrative burden or losses.

Contact us for more information.

Now, take it a step further.

• Do you know how to effectively and efficiently secure those payment methods for future use?
• How do your patients respond when asked to keep a card on file?
• Are you even doing these things today?

Many providers struggle to find a happy medium when it comes to speaking to their patients about financial responsibility and actually collecting. we will explore the top ways to optimize your patient collections strategy without costing valuable time and labor resources.

It’s crucial that you obtain every dollar for every visit in a timely fashion. Collecting payments is easier when you have some expert assistance backing you up.

Here are six tips your practice can implement to avoid revenue loss due to the rise in high-deductible health plans and patient’s resulting financial responsibility.

1. Gather patients’ insurance and contact information before their appointments.
2. Verify insurance eligibility and identify any amounts due from prior patient visits.
3. Collect copays and other balances at the front desk when patients check in.
4. Offer multiple payment methods.
5. Offer payment plans and track them.
6. Make follow-up part of the collections routine.

To Conclude:

Collecting more patient payments with less delay should be your new goal, keeping in mind that your practice is a business and that your patient is the consumer. While you are in the healthcare field to help others, you also have a duty to your staff to collect what is owed, making payroll and keeping the doors open.

In the past, most reimbursements were carried out through a business-to-business relationship between providers and insurers, leaving patients largely out of the loop. But now and in the future, reimbursements are a business-to-consumer relationship that is forged between providers and the patients themselves.

There are a lot of moving parts to consider when it comes to getting timelier payments from more of your patients. You may have additional questions or concerns about payment collection that you’d like to address immediately.

The least expensive time to collect is right now…it gets real expensive to collect money tomorrow!”

Click here http://localhost/main-site-update/live-demo/ to schedule a conversation with a WWS experts.

One of the biggest challenges, which also has a direct impact on the revenue collection of most practices, is credentialing i.e. enrolling with the best insurance service provider. This is not really as simple as it sounds. With so many insurance providers having opened shop, it is not easy to tell which one would be the best for a particular medical practice. No wonder then that most practices prefer to outsource their credentialing services as this would mean one less thing to worry about.

Are you still indecisive about whether to outsource your medical credentialing?

Well, take a look at these pointers which will help you understand when the time is right to outsource your practice’s the credentialing process.

1. Big process

Collecting the necessary details from the patient and other stuffs are a big process which should happen flawlessly. If the billing service staff is employed to collect all these details then it is pretty hard for that single employee to take care of all such things. So it is better to connect with insurance service provider.

2. Lessen your burden

When you take a step forward by implementing software and appoint an insurance provider employee for claiming reimbursement then it becomes an easy task for everybody. Every employee will have his own work to do. The number of workforce will also be increased along with that the technology will also be implemented.

3. Experts on role

If your healthcare industry is less experienced in such insurance stuffs leaving them in experts hand can lead to no denials or rejections of claims. Experts will do their job professionally and minimize the risks of rejections in claims.

Here, you will find our Step-by-Step Physician Credentialing Process

1) Week 1 Strategy and Information Gathering

a) During the first ten days or so after signing an agreement, our team will work with you to massage your payer list and ensure all relevant payers are included.

b) In addition to the payer review, your account manager will work with you to ensure we have everything needed to submit and process your applications.

2) Weeks 2-5 Application Submission & Follow up

a) During this time we will contact all insurance companies and begin the application process.  Some of them require an LOI (letter of interest) and others want you to submit a form on their website.  Regardless of how they do it, we will take care of all of this.

b) Once the requests to join the network have been submitted, this is when the follow-up process starts and continues until everything has been finalized.

3) Weeks 6-9 Follow-Up & Contracting

a) During this period we will continue to follow up and should begin to see your application making it through the payers credentialing process.

b) Once your application has made it through the initial process, we will now ensure it transitions smoothly into the contracting phase.

4) Weeks 10-16 Contract Negotiations & Effective Dates

a) This is when things start to get fun.  Agreements are coming in and you’re beginning to see some results.  Payer agreements are reviewed and submitted to you for signature (if they don’t need to be negotiated).  Once signed, these executed agreements are returned to the payer for loading.  The loading process with some payers can take an additional 30-45 days.

b) Finally, we will work through your payer list and ensure we have effective dates and provider IDs for all applicable payers.  We will then work with you to provide this information to your billing company or department.

EndNotes:

Outsourcing your credentialing is the equivalent of a primary care physician referring to a cardiologist when a patient presents with an irregular heartbeat. While the primary care physician could very likely handle the problem internally, is the risk of missing something serious really worth it? That’s really what you must ask yourself. Based on national credentialing surveys, the average time for a physician to be credentialed by a group is 180 days whereas most of our payers are completed in 90 days.  Is finishing the process faster and more accurately important to you? If it is, we believe you’ll reach the logical conclusion that outsourcing is the answer.

If you have any questions write us @  support@wonderws.com   or Schedule a 30 minute Complimentary live demo on our customized credentialing solutions.

Whether it’s a simple human error or an inefficient process, making a mistake could impact your bottom line. These processes may be time-consuming and arduous, but it’s they’re absolute necessities for your practice. 

Unfortunately, it’s easy to make a mistake during these function.

The sooner your credentialing mistakes are taken care of, the sooner you can focus on the day to day issues of serving patients and receiving timely payments. Ignore the significance of provider credentialing at your own risk it is certainly one of the most important compliance issues that a medical practice encounters.

To help achieve that level of perfection, here are the four biggest mistakes you should avoid during the credential process:

1. Not Completing/Incorrect Applications
2. Neglecting To Follow Up
3. Waiting To Start The Process
4. Not Assigning Roles To Your Staff

1. Not Completing/Incorrect Applications

• If you want to avoid denials and delays, you need to make sure that an application does not contain any errors and are filled out entirely.
• A credentialing application will ask for important pieces of information such as contact information, employment history, phone numbers, and other important records.

2.  Neglecting To Follow Up

• In order for credentialing to be a successful process, an organization needs to continuously follow up with its payers.
• You need to stay on top of them to ensure they are processing your applications in a timely fashion.  
• Don’t be afraid to reach out to them to check on the status of the applications.
• Try to get in the habit of contacting them on a routine basis to monitor the status of your submissions.

3. Waiting To Start The Process

• There is no time for procrastination in the credentialing process.  
• You need to get the train rolling as soon as possible.
• It can take a while to complete a thorough background check of a doctor, so you  will want to give your organization at least a couple of months before any doubts set in just in case there are any issues.

4. Not Assigning Roles To Your Staff

• Since there is so much that goes into the credentialing process, you need to have a competent team in place to ensure it is always running smoothly.
• All too often, organizations do not assign roles for staff members to manage the workload.
• For example, you need people who will enter data/ensure its accuracy.  If there are loosely defined responsibilities within your organization, it will cause errors which will lead to denials and delays.

Ultimately, the best way to prevent mistakes that can hinder or even derail the #credentialing process is to utilize specialists familiar with the entire process. Our skilled experts will work with you to streamline and speed up your credentialing process. 

Contact us for more information for more customized credentialing options suitable for your practice needs.