Managing new entity and payer enrollment with payers can be a complex, time-consuming process for health care organizations. Whether launching a new practice, merging with another entity or expanding into new markets, the administrative burden of enrolling with insurance payers and Medicare/Medicaid is significant. From navigating payer-specific requirements to meeting tight deadlines, it’s easy for health care providers to get bogged down in paperwork and compliance, pulling focus away from patient care and growth strategies.
Challenges of New Entity Enrollment
Entity enrollment, also known as credentialing, involves enrolling new health care providers or entities under a client’s Tax Identification Number (TIN) and billing National Provider Identifier (NPI). This process can take anywhere from 30 to 180 days, depending on the payer, with Medicare often requiring at least 30 days to complete. Even after completing the application, the effective date may not be set for months, complicating operations and impacting revenue flow.
A key challenge is Medicare’s retroactive policy, which allows retroactive coverage back 30 days from the receipt of a complete application. While helpful, this retroactive window means that if the application process is delayed or incomplete, the provider risks losing revenue. Additionally, secondary payers may have different timelines and requirements, adding another layer of complexity. Non-compliance, particularly regarding Medicare and Medicaid enrollment, can lead to penalties, delayed reimbursements or even exclusion from payer networks.
Complicated and Time-Intensive Processes
Enrolling a new health care entity with payers involves more than just filling out forms. Each payer has its own set of requirements, deadlines and compliance checks, which can vary by state or region. For busy practices, dedicating internal resources to manage this process can lead to delays and missed opportunities. The intricate process can often take months, and errors can result in enrollment rejections or costly setbacks.
Tracking of Changing Payer Requirements
Insurance payers frequently update their enrollment criteria. Your staff must continuously monitor these changes, ensure compliance and adapt to varying timelines—all while handling their existing workload. This increases the likelihood of missing important updates or deadlines, further delaying enrollment and reimbursement.
Impact on Revenue Cycle
Delays or errors in the enrollment process can have a direct impact on your revenue cycle. If a new provider or entity is not properly enrolled, your organization may face delays in receiving payments from insurers. These disruptions can create cash flow issues to your revenue stream and ultimately affect your entire health care organization.
Benefits of Outsourcing New Entity Enrollment
Outsourcing payer enrollment to a third-party provides a solution that simplifies these challenges, freeing up health care providers and other resource types to focus on your core mission: patient care. Third-party enrollment consultants have experience in minimizing disruptions and ensuring a smooth enrollment process. Here’s how outsourcing can help:
Experience and Efficiency
Third-party enrollment services specialize in navigating the complexities of payer enrollment. They have the up-to-date knowledge necessary to efficiently manage your entire process, from completing payer applications to monitoring compliance. With dedicated teams, third-party providers can often expedite the enrollment process, reducing delays and minimizing the risk of errors.
Tailored, Scalable Solutions
Outsourcing provides flexibility and scalability, making it easier for health care organizations to handle fluctuations in workload. Whether your practice is growing rapidly or navigating a complex merger, outsourcing partners can scale their services to meet your unique needs. This level of customization ensures that your enrollment process runs smoothly, no matter the size or scope of the project.
Regulatory Compliance Support
A reliable third-party enrollment service will not only ensure accurate and timely enrollment but will also help safeguard your organization’s compliance with payer and government regulations. They’ll stay on top of updates to Medicare, Medicaid and commercial payer requirements, reducing your risk of non-compliance and avoiding penalties.
By outsourcing new entity enrollment, your health care organization can significantly reduce internal administrative burdens and costs associated with training staff or managing payer relationships. With a third-party managing the process, your team can devote their time and energy to revenue-generating activities and patient care, improving overall efficiency.
Anders Health Care advisors offer tailored payer enrollment solutions to help health care organizations like yours navigate these challenges with ease. Learn how we can support your practice’s growth and operational efficiency, and the associated costs, by requesting a meeting below.
