In order to provide the best possible care to your patients, your practice needs to stay revenue-positive. In order to ensure that you can accomplish this, you’ll need a significant list of patients who understand your practice as “in-network,” meaning their insurance companies will accept your bills. This is accomplished through provider enrollment.
At its most basic, provider enrollment—or “payer enrollment”—is the application process for healthcare providers of all kinds to be included in any given health insurance network. Once you are accepted into a network, you’ll be able to bill the insurance company for services you provide to any patient who carries that insurance. The insurance company will also list you as a provider in their network, meaning patients with that insurance will be more likely to seek your services. The average health care provider works with 25 insurance providers.
Let’s take a look at some basics about provider enrollment, and how credentialing fits in with it. We’ll also discuss how to make the process as easy as possible, and limit the stress it puts on your team.
Phases of Provider Enrollment
The process of provider enrollment is divided into three distinct phases:
- Application - The first phase includes deciding which networks to apply to. This should include consideration of which networks serve the people in your community, and how reliably they will compensate for the particular services you provide. In order to avoid claim denials, you want to ensure that the services you regularly provide will be covered by the insurance companies you are partnered with. Each practice may have a different set of companies to which they can more beneficially apply. This is a long process, so you want to ensure that you’re starting off by making good choices about who to engage with.
- Credentialing - Another common term used in medical billing, provider credentialing is phase two of the provider enrollment process. If your application is accepted by the insurance company, you’ll move on to credentialing. This is how the company confirms that you are a legitimate health care provider whose services they can compensate. They’ll verify your performance, license, background, and qualifications. You’ll need to submit quite a lot of documentation, including diplomas, certifications, affiliations, tax information, proof of insurance, work records, immunizations, and even more. During this phase, improper submission can result in long delays, or even the need to start over, so it is imperative to check and double-check everything you submit.
- Negotiation - After the insurance company confirms that you are a competent and legitimate health care provider, they’ll offer you a contract. The contract will include a designated date on which you can start billing them for services you provide to patients in their network, among other terms of your partnership. Perhaps the most important of these are the rates at which you will be reimbursed for services and supplies. If these do not match your expectations, you’ll want to negotiate before signing the contract.
The Importance of Provider Enrollment
A successful plan for provider enrollment should help bring new patients to your practice, help you be paid at a higher rate, and help expand your practice over time. On the other side of the coin, an ineffective plan—or no plan—can end up leaving you with huge financial losses, fewer patients, lower quality of service, and ultimately damage your practice’s reputation.
While provider enrollment is a complex process that can cost quite a bit of time, it should still be among your first priorities. Anything but careful and regular engagement with the process can end up costing you even more time and money. It’s also worth noting that you will periodically need to update your credentials with the insurance providers you partner with, and any mistakes made during this process could result in the suspension of your contract.
The credentialing process takes up to 90 days. Negotiations over a contract may add another 30–45 days. These numbers are the average. Any mistakes can result in significantly more time being added to the process. This represents hundreds of days in which you could be missing out on important revenue for your practice.
Provider enrollment may be the most important aspect of running your practice, outside of providing excellent care to your patients. Because it is so important, time-consuming, and indirectly related to patient care, many practices choose to outsource this aspect of administration. Healthcare Revenue Group focuses on provider enrollment and other medical billing services for medical practices of all types, with a special depth of knowledge when it comes to audiology and podiatry practices.
Contact Healthcare Revenue Group today about how we can set up a thorough and effective billing strategy for your practice that will help you gain revenue, grow your practice, and let you focus on what you do best—patient care.
