Are you facing significant hurdles with provider enrollment and credentialing? Is this negatively impacting your cash collections?
We understand and we hear it every day.
With streamlined and efficient provider enrollment processes, physicians can focus on healing and saving lives, while patients receive quality care. Keep reading to learn how Legacy Consulting Services brings significant benefits compliance, and frees up time for patient care.
Credentialing
Provider credentialing is a careful check to make sure that doctors, dentists, and other healthcare professionals have the right qualifications, like education, training, and licenses, to take care of patients. Hospitals and health plans double-check this information before they let the providers join their network. That way, all healthcare workers are held to the same standard. Credentialing also ensures that patients receive the highest level of care from those healthcare professionals.
Provider Enrollment Services
Provider enrollment services, on the other hand, are like the administrative glue that holds the system together. They handle the paperwork and bureaucratic hurdles necessary for healthcare providers to be officially recognized and reimbursed by insurance companies or government healthcare programs.
Without these services, providers might struggle to get paid for their services, leading to financial strain and potentially disrupting patient care.
Errors or oversights in provider enrollment can result in significant revenue loss for healthcare providers, as claims may be denied or delayed due to enrollment discrepancies. Provider enrollment services employ quality control measures to try and prevent such errors, ensuring that providers’ enrollment information is accurate, up-to-date, and consistent across all payer networks and healthcare programs.
It’s All in the Details
These services are part of an intricate process within the healthcare system and can directly impact patient care and revenue streams. That’s why it’s critical to hire a consulting team that focuses on these critical elements:
- Attention to Detail: Ensures accuracy and compliance with regulatory standards. When submitting information to payors, remember they are sticklers for details. Everything must read exactly the same as they have in their records, from addresses to NPIs to names to banking information and so much more.
- Organizational skills: Essential to keep track of numerous documents, deadlines, and communications with various stakeholders (physicians, nurse practitioners, payor representatives) involved in the credentialing process.
- Diligent follow-up: Necessary to address any discrepancies or delays promptly, ensuring that providers are credentialed in a timely manner. And don’t forget revalidations. Missing a revalidation within the appropriate timeframe will deactivate your status, stop cash flow and require going through the enrollment process again.
- Reimbursement and Revenue Cycle Management: Proper enrollment ensures that healthcare providers can bill for services rendered and receive timely reimbursement from payers. Otherwise, providers may face delays or denials in payment, leading to financial strain on their practices.
If these factors are overlooked, errors or oversights may occur, leading to disruptions in patient care, revenue loss, and potential compliance issues.
How Legacy Consulting Services Can Ease Your Workload
Legacy Consulting Services leverages extensive expertise and resources to streamline the credentialing and provider enrollment process.
With a team of Credentialing Subject Matter Experts (SME’s), who possess in-depth knowledge of regulatory requirements and industry best practices, Legacy Consulting Services ensures accuracy and compliance at every stage of the credentialing journey.
Legacy Consulting Services offers personalized support and guidance, working closely with clients to understand their unique needs and challenges.
Other Benefits of Working With Legacy
Council for Affordable Quality Healthcare (CAQH)
CAQH enrollment and regular updates are essential for healthcare providers as they centralize and streamline the credentialing process, reducing administrative burden and ensuring accuracy of provider information across multiple health plans.
Legacy Consulting Services efficiently manages CAQH enrollment by assisting providers in completing and submitting applications accurately and promptly.
We also ensure regular updates to CAQH profiles, reflecting any changes in provider credentials or practice information. This process creates smooth interactions with various health plans and optimizes the reimbursement process.
Hospital Privileging for Providers
Hospital privileging is crucial for providers as it grants them the authority to deliver specific medical services within a hospital setting, ensuring optimal patient care and safety.
We also advocate for providers, expediting the privileging process and ensuring seamless integration into hospital settings.
Working with Payors Nationwide
Dealing with various payors, such as Medicare, Medicaid, governmental, and commercial payors, presents a challenge due to differing regulations, documentation requirements, and submission processes.
Legacy Consulting Services excels in navigating this complexity by maintaining a deep understanding of each payor’s unique requirements and staying aware of regulatory updates.
We ensure that clients meet the stringent standards of each payor, facilitating efficient enrollment and credentialing processes.
Support for Value-Based Care Models:
Value-based care models emphasize the delivery of high-quality, cost-effective care that focuses on patient outcomes rather than volume of services. Provider enrollment services help providers participate in value-based care initiatives by enrolling them in accountable care organizations (ACOs), bundled payment programs, and other value-based reimbursement arrangements.
Don’t Delay
Delayed credentialing and provider enrollment have significant financial implications for healthcare organizations, directly impacting revenue streams and patient care. Some examples include:
- Billing denials/delays, leading to revenue loss due to write-offs of charges for services rendered
- Providers being unable to participate in certain insurance networks, limiting patient access to essential healthcare services
- Patient dissatisfaction/potential loss of clientele
- Strained resources and administrative staff, diverting attention away from patient care initiative
By partnering with Legacy Consulting Services, your organization can benefit from tailored solutions, proactive support, and expedited credentialing timelines. Contact us today to ensure smooth operations and revenue optimization so you can focus on your core mission of delivering high-quality patient care.