Payer enrollment is maybe one of the more essential, yet misunderstood pieces of the puzzle. No doubt, making your practice’s providers billable needs to sit atop your to-do list, yet satisfying the procedure requires a bit more know-how and determination than many, if not most, healthcare professionals are aware.
One of the most vital concerns when it pertains to payer enrollment is that many underestimate how mind-numbing and chaotic this process is apt to be. Keeping up with the ever-shifting regulations of each health plan can absolutely turn out to be a deviously ineffective task, triggering unnecessary worry and irritation for all involved. Failure to stick to the obligatory timelines, however, can result in stoppages in enrolling providers into health plans, which can ultimately bring the entire procedure to a complete standstill.
Payer Enrollment and Credentialing, What’s the Difference Between the Two?
Most persons are baffled when it comes to credentialing vs. payer enrollment. Provider credentialing is the method by which a new physician or healthcare provider authenticates their qualifications – their credentials — to offer specified services and medical care. This usually takes in furnishing documentation of the person’s license, training, education, and career. It is, nevertheless, a bit more difficult than it might sound, as, when possible, the information originates from the source of the qualification, for example, the medical school, licensing agency and prior employer/practices.
Payer enrollment, on the other hand, is the procedure of registering healthcare providers with health plans. Why is it essential to enroll with payers? By enrolling, providers are then considered as “in-network” or “participating.” Being enrolled as such is critical, as most patients simply won’t pay the higher copay to be seen out-of-network.
This aversion to paying more to see non-participating providers stems from the steeply rising costs of health insurance that already weighs down most people. Today, patients pay out an average of 30 percent more for health coverage in the form of deductibles and out-of-pocket expenses than they did only seven years ago.
Which payers, then, do you need to get providers enrolled with? Your providers should enroll with all major payers in the region. Discovering which health plans are the most familiar in your area is the first step. To help in determining which health insurers you might want to do business with, take a good look at the various groups of payers.
First, you want to be certain your providers are enrolled with the top insurance companies, such as Aetna, CIGNA, Humana, United HealthCare and BlueCross/BlueShield, among others. In addition, there may well be a number of regional payers that your patients might be using.
Of course, you also want to enroll with government-operated programs such as Medicare and Medicaid. Bear in mind that these are inclined to be a bit more complicated, and you need to allot enough time to complete the process within the required timeline.
What’s the Major Cause of Confusion Concerning Payer Enrollment?
Underrating the amount of time it takes to finalize payer enrollment with each health plan is by far the most substantial issue that regularly leads practices to have issues with the process. Most have little or no notion of how time-consuming these processes can be or the quantity of information that’s entailed.
How Long Does the Payer Enrollment Process Take?
The length of the process can differ vastly from one health plan to the next and one state to another. On the whole, 30-90 days is a realistic estimate. Yet, 4-6 or more months isn’t totally unrealistic. Most insurance companies will not allow you to tender your application prior to 60 days in advance of the provider’s start date.
Why Should I Consider Outsourcing Payer Enrollment?
There are a number of persuasive reasons why a growing number of healthcare providers are opting to employ outside firms to administer payer enrollment for their practices. searching for professionals in this area offers a number of benefits.
- Specific know-how. Companies, such as Medwave, not only have a comprehensive grasp of payer enrollment and credentialing, but also the skill, contacts and awareness to make the process as easy as possible. Owing to their years of experience, these companies also know how to heighten issues and appeal adverse decisions.
- A decline in enrollment errors. Working with enrollment experts will dramatically cut the possibility for enrollment data mistakes, one the more common causes for delays. This feature by itself will save you both headaches and weariness. Making less errors will boost the total experience and help you get your insurance payments sooner.
- Save money on employee training. When you outsource your payer enrollment, you needn’t be concerned about training your staff and placing all the accountability on one person. Your payer enrollment expert at Medwave will willingly remove all the bothersome tasks from your plate. He or she will perform the follow-ups, make the essential phone calls and send the necessary faxes and emails.
Why Should I Consider Outsourcing Credentialing?
The two chief paybacks of outsourcing your credentialing are cost savings and speed. There is no need to hire, train or pay an in-house team when there is presently a team out there already trained and all set to help. This provides your office staff the time to devote to your practice and your patients. Credentialing services such as Medwave can often implement these services much quicker and without as many errors, which can also help you capture more revenue and see patients faster.
Medical provider credentialing is turning out to be a foundational task. Organizations can’t bill for services without the provider being authorized by all payers. The credentialing process assures that the provider meets precise criteria set down by health insurance firms. Consequently, credentialing enhances patient trust, reduces the risk of would-be risks and boosts the practice’s reputation.
Although credentialing can be inefficient and time-consuming, the benefits outweigh the risks. Moreover, having a detailed and accurate credentialing process enhances cash flow by reducing the time it takes to include a new provider to your insurance panels.
For complete information on payer enrollment and medical credentialing, please contact the professionals at Medwave.
