Medicare is the largest payer for most practitioners, so it’s important that providers maintain current credentials. Medicare requires providers to revalidate every five years to verify credentials and ensure they meet Medicare qualifications. Providers must confirm or update information including the legal entity name, physical address, phone, fax, national provider identifiers, employer identification number, and board certifications and licenses if applicable.
While typically a straightforward process, if not completed correctly and on time, providers will be terminated from the program and required to reapply. Until a new application is processed and approved, which can take anywhere from 90-120 days, reimbursements will stop, disrupting the revenue cycle.
Occasionally, providers may receive off-cycle revalidation requests. These are typically triggered when anomalies are identified such as billing rates that are significantly higher than other providers in the same geography, billing for services not rendered, or billing patients for services that Medicare doesn’t allow.
To comply with Medicare revalidation requirements, providers need to know their revalidation schedule and make sure applications and supporting documentation are submitted through Medicare’s PECOS online application portal. Revalidation dates cannot be extended, so it’s important they’re submitted on time. Using a third party to navigate the nuances of Medicare revalidation and PECOS removes the burden from provider staff and ensures accurate and timely filing.
Having nearly four decades of experience working with payers and providers, the TPS credentialing experts understand the importance of maintaining current credentials. Contact us to learn more about our Medicare revalidation services.
ABOUT EZCLAIM: As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
It’s safe to say that healthcare practitioners are well aware of the importance of credentialing. Beyond the legalities required of practicing physicians, credentials are needed for a practice’s revenue cycle to function properly. If providers aren’t enrolled with payers, they can’t receive payment for submitted claims. It’s as simple as that.
New and existing providers are required to maintain credentials and it’s not an easy process, even for the most well-oiled office. In order to take on the most patients and collect optimal revenue, practices also need to accept a wide array of payers. In fact, there has been a 5 percent uptick in providers enrolled with 10-20 payers, according to VerityStream’s 2018 Provider Enrollment Survey. Gaining enrollment with these payers involves verifying qualifications in order to accept patients, submit claims and ensure a steady stream of cash. Administrators need to collect the educational history of providers, fill out forms and submit the applications. It sounds easy enough, right?
Think again. There are hours of administrative work needed and a high risk for human error, with any hiccup in the process likely causing delays. It’s been said that up to 85% of credentialing applications are incomplete, which could cause delayed billing, lost revenue or even audits.
When it comes to credentialing, time is money. A 2016 survey by Merritt Hawkins found that a non-credentialed doctor was losing approximately $6,600 a day. Multiply that by the total amount of physicians in a given practice, and the potential losses are staggering.
Credentialing is a necessary evil, so do you handle in house or outsource? That’s the million dollar question. Utilizing current staff resources sounds like the easy solution, but does your organization have a dedicated employee to focus on your credentialing needs? Probably not. Chances are, this employee is pulled in many directions and isn’t able to dedicate time solely to credentialing. And if you do plan to handle the process with current staff, are your employees well-versed in all payers and their processes? Factor in learning curves or potential staff turnover and the time associated with training new employees and the not-so obvious financial costs quickly add up.
So how does the average practice streamline the process and ensure that credentials are gained as painlessly as possible? The old adage “you get what you pay for” could easily apply to this scenario. Hiring an outside resource means you are essentially paying for expertise and efficiency, which will save time and money in the long run. Why wouldn’t you want to utilize expert resources with in-depth knowledge of payer and state nuances? However, before making a decision, you need to know how much your practice could save by using a third party. Knowledge is power and having an accurate picture of your potential revenue is the first step to determining the best option for your organization.
Access the credentialing ROI calculator from TriZetto Provider Solutions, a Cognizant Company, to receive an estimate of potential revenue savings. Discover the hidden costs associated with the credentialing process and see just how much revenue your practice could gain in 2021. You’ll gain enrollments quickly and accurately, keep employee satisfaction levels high (since they won’t be burdened by the process) and ultimately, increase revenue.
Don’t allow the complicated payer credentialing and enrollment process to be a burden on your practice. The credentialing experts at TriZetto Provider Solutions have experience working with various payers and providers of all backgrounds. Our team will collect and submit information in a timely manner and perform all necessary follow-up tasks. Let us lighten your load so you can focus on patient care and growing your practice.
[Contribution by TriZetto Provider Solutions Editorial Team]
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