Four Tips to Meet the Start Date Challenge with Payer Enrollment

Four Tips to Meet the Start Date Challenge with Payer Enrollment

May 7, 2019
  • Author:
    Kay Lynn Akers, CPCS
    Former VerityStream Employee
    With over 30 years of health care experience, Kay Lynn Akers brings direct insights into the challenges of the evolving industry. During her tenure at VerityStream, she has provided clients with consulting and services to assist in deploying new solutions, identifying process improvements using solution best practices and designing solutions to meet the needs of organizations across the industry. Her healthcare contact center and care provider background establishes her record of shaping solutions for clients with projects ranging from optimizing processes and software for maximum efficiency and service to supporting large consolidations.

One of the common challenges facing provider enrollment teams surrounds the start date for new providers. Every month with an open physician position means lost patient revenue.  Conversely, if the provider starts before enrollment has taken place also results in lost patient revenue and/or holds.

How do organizations address this challenge when setting start dates?

Data: In order to determine lead-time needed to enroll providers it is necessary to have information. How many days does it take to enroll a provider? Not just overall, but for each payer.

Additionally, you will need to know what the payer mix of the patients in your market. If only 5% of the patients have payer X, it is not as impactful if the provider starts before enrolled.

Delegated Credentialing: There are many benefits for entering into delegated credentialing agreements with payers when possible. Not only does it decrease administrative “paperwork” for providers it also reduces turnaround time for enrollment with the ultimate benefit of quick reimbursement. It’s a win-win-win!

Collaboration: Provider start dates should not be a battle between recruitment, onboarding, credentialing and enrollment teams. It is important for each team to educate the others and work together to improve provider enrollment timeframes.

For example, recruiters might not know the impact aggressive start dates have on the organization in terms of lost revenues and claims holds and conversely the enroller might not know the considerations used to determine start dates for individual providers.

Flexibility: Last, but not least, it is important to understand a quick start date might be set because of other priorities. For example if the organization is in dire need of that specialty the benefit of keeping/attracting patients outweighs minimizing lost revenue from claims. This is just one reason why exceptions to normal lead times occur.

These are just a few strategies to help meet the needs of patients and providers while ensuring the most reimbursement for the organization. Are you ready to get started?