Provider Enrollment: The Complex, Critical First Step in RCM

 In Advantum Health Blog

We all do it. Multiple times a year, we pack our bags and board airplanes headed for business meetings, work conferences, or, if we’re very lucky, far-flung tropical destinations where we swear we’ll completely unplug for 7 days and 6 nights.

The Take-off

The jam-packed 737 we board is full of so many moving parts that must all operate individually, as well as work in sync for us to safely arrive at our final destination and plunge our toes into cool sand. Similarly, the various parts of the revenue cycle for a large hospital system or medical practice must work independently and in unison to receive maximum and total reimbursement for every collectible dollar from patient appointment to claim payment.

Revenue Cycle Management (RCM) has been a hot topic in healthcare and everyone is looking for ways to close gaps and beef up their bottom line, but how do you do it? What are you missing? Many believe the answer is seeing more patients or expanding the number of services you offer, but the root of the problem often does not lie in patient volume or the number of services available at your practice.

The Key to a Successful Flight

Provider enrollment is an integral, and often downplayed or overlooked, first step of the entire revenue cycle. So frequently a hospital enrollment department or office manager at a medical practice thinks they know which payers each of their providers are participating with, but their information is out of date or inaccurate. The office manager may not be familiar with the different plans and lines of business and what needs to be done for providers to be considered in network or may simply be wearing too many hats to have the time to focus much attention on credentialing and provider enrollment. Providers may be enrolled incorrectly or not properly linked to the group’s Tax Identification Number, or timely recredentialing may not be happening.

No matter the issue or the reason, if provider enrollment is a tangled, incomplete mess, claims will be denied, payments delayed, and money will inevitably be lost. Now let’s circle back to our earlier analogy. If a plane were to take off without enough fuel you would, at best, be delayed in getting to your destination. If you begin your practice or perform procedures at a hospital prior to the completion of your enrollment or credentialing verification, the odds of you receiving prompt and accurate payments is slim.

Smooth Landing Ahead

Luckily, Advantum Health can be your pilot in the evolving complexities of healthcare administration. We ensure your practice is functioning optimally and earning as much money as possible. Our comprehensive portfolio can guide your practice through the entire revenue cycle from enrollment and credentialing to billing and payment collections.

For more information about provider enrollment or credentialing verification, click here.

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