Payer Enrollment Tips for Small Practices

Shrinking reimbursement from payers is on a collision course with rising out-of-pocket responsibility for patients. Last year, Physicians Practice reported that independent physicians are often reimbursed 20 to 30 percent less for certain CPT codes. While the reasons may vary, the broader lesson is that these providers must pay sharper attention to managing payer relationships and tightening up wherever they can. There is no cushion to fall back on, even if patients increasingly pay more for their care. The reality is they struggle to do so.

This makes maintaining payer relationships even more imperative. Should a provider be dropped from a plan, it would be folly to hope the patient could pay in full for any remaining treatment. To that end, the independent practice must lessen revenue dependence on a relative handful of payers--and instead, sign up with more plans to grow their practice and revenue.

To do so without also growing their administrative headaches, practices should consider using a newer platform and services. One such option is an online, subscription-based service for credentialing and onboarding. Bolstered by these services, physician practices can adopt the following strategies to reap more revenue, more efficiently, from health plans.

Centralize provider data

The information providers need to join a new health plan often resides in different files, folders and with different employees. Nothing slows down enrollment in another plan more than an extended chase for applications, licensing and credentialing forms, and any of the myriad of documents payers require. Compounding this chase is the typical high turnover of front desk personnel that many practices rely on to stay on top of enrollment and re-credentialing. But they aren't-which is why many practices are enrolled in fewer health plans than they could be. It's just too cumbersome to do on a regular basis.

One of the biggest benefits of an online credentialing service is that it centralizes all the documentation in one location. The best services load this hub with all the most current forms required by almost every payer and health plan. This centralized location will include the right contacts for each payer, and information that cuts significant time from the onboarding process. It can also store the subsequent payer contracts, for easy lookup when needed.

The upshot: every authorized person at the practice has access to all information, in one convenient location, needed to join and remain in a plan.

Stay ahead of deadlines

There are so many important deadline dates for practices to remember that inevitably they forget some of the most important.

This is an unacceptable reality for physicians and patients alike. An online credentialing service can bring order to chaos, tracking status and sending automation notifications when expiration dates are looming for credentialing applications, license, malpractice renewal and more.

Position for continuous, efficient communication with payers

While some online credential services perform all the above functions, not all are tapped into a wider network of payers and providers across the country. Those that are can help small practices steadily automate more communication processes with payers. One of the most important is communicating provider directory updates-which payers are mandated to ask for. As such, providers are getting inundated with these requests. If they can't fulfill them on a timely basis, they will inevitably be incorrectly listed in a directory, which could prevent them from seeing more patients.  

In short, it's to the provider's benefit to be accurately listed on the payer's list of member providers. Those online credentialing services that enable mass provider directory updates, re-credentialing and more can whittle the provider's administrative time even further.

Finally, it matters to think not just in terms of enrolling, but also renewing. Information must stay updated and readily accessible when the time to re-credential rolls back around. With an online subscription process, the process won't entail another protracted chase for the right information.

It is becoming paramount that such frustrating drudgery comes to an end. Study after study is connecting severe physician burnout with documentation and administrative overload. That's one more challenge to add to a list that includes shrinking reimbursement and the rise of high deductible plans that leave patients scrambling to pay for care.

While reducing documentation won't solve all of healthcare's problems, it will mitigate one of the biggest - poor provider and payer relationships - and put the small practice back on sound financial footing.

Neerak K. Sharma is the Chief Operating Officer at Santéch Solutions