Encompass uncovers hidden payer enrollment error saving new client an estimated $1.7 million

January 11, 2019

Think twice before making your medical office staff responsible for provider payer enrollment
Jamie Amedee, CPCS Director of Provider Credentialing & Enrollment

During the discovery phase between Encompass and the client, the Encompass team discovered a costly payer enrollment error that could have negatively impacted their bottom line. Their revalidation number was incorrect, which meant dis-enrollment from billing their Medicare professional fees. The Encompass team took the appropriate steps to correct the error and saved the client an estimated $1.7 million dollars in revenue. 

There is a fast-moving push by Medical Staff Professional speakers, consultants, and educators to align Medical Staff Credentialing, Provider Enrollment, and Delegation within an organization. This is largely in response to the cry for help from healthcare organizations who have recognized the impact that non-existent or poorly timed government and commercial provider payer enrollment can have on their revenue cycle. While it is positive that the importance of these tasks are getting their due time, payer enrollment is a critical business process that should not be a back-office function that lacks strategic importance.  This proved true for a new payer enrollment client.   

The first step in formulating a strategic plan to handle the Payer Enrollment function in your organization is to quantify the potential opportunity inherent in your organization today. Being highly skilled in managing provider data is not enough when faced with the task of enrolling providers in contracted healthcare plans. Provider payer enrollment is a reflection of how an organization bills for patient services. It is, therefore, critical that those charged with completing payer enrollment applications are well-versed in the organization’s billing practices. 

Encompass’ Provider Credentialing & Payer Enrollment team has over 125 years’ combined experience in strategic credentialing and enrollment. Our team, led by a Certified Provider Credentialing Specialist, will file, track, and update the endless stream of paperwork that comes with maintaining and growing your practice. While you focus on patient care, you can rest assured knowing that we will keep your practice up-to-date so there are no gaps in coverage. New providers will be ready to see patients and get paid through proper insurance channels from day one, eliminating any possibility for lost revenue while ensuring data integrity.

Click here to begin understanding the magnitude of your organization’s risk.

About Encompass:
Encompass Healthcare Data Solutions is a practice management firm that leverages the latest technologies in IT & data science, revenue cycle management, clinical quality management, human resources, and provider credentialing and payer enrollment.

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