Expanding your practice and bringing new providers on board is exciting but equally perplexing, involving many parties and moving parts. The events and surprises of 2020 have exacerbated the stress this process put on practices. Income and operational stability are on top of most practice’s priority list, and provider enrollment with insurance payors is the first step in your revenue cycle. Proper and timely enrollment is a must-have if you want to reinforce your revenue streams. Here are the common pitfalls to avoid in securing enrollment with payors.  

  1. Unfamiliarity with the payors in the area where you are expanding. 

The first step in proper and timely payor enrollment is to familiarize yourself with the payors in your service mix. Although it seems to be a table stake, many practices overlook small differences in process and requirements when expanding into a new area, ultimately delaying their applications.  

Try to overcome the urge to rely on your experience and do not assume that payors all use the same standard process. In researching the new payors in your area, make sure you properly size the effort you will need to put into your application process, including time, effort and human resources. This will help you plan your service more accurately and avoid unexpected disruption.  

  1. Failure to collect your providers’ information prior to beginning the enrollment process. 

Once you have familiarized yourself with the enrollment requirements and process, give yourself ample time to gather all necessary information prior to beginning the enrollment process. Another pitfall in the enrollment process is underestimating the amount of data and documents required to complete applications, even if you are re-enrolling.  

 Make sure you dot all the i’s and cross all the t’s – even the slightest discrepancy in data may bring your enrollment process to a halt. Common information gaps that can delay your enrollment with a payor include gaps in work history, ownership information, hospital privileges and missing signatures (yes, you read it right!)  

Complete and honest disclosure of the information is critical in ensuring a smooth enrollment with payors. Resist the urge to hold back negative information such as malpractice cases or suspended licenses in other states – it will surely come up in the enrollment process and does nothing but put your application in jeopardy.  

  1. Not pushing back when a payor says that “the panel is closed” to your provider types. 

“The panel is closed” is the type of response that instantly puts many practices into panic mode.  

In the unfortunate event that you are faced with a closed panel, don’t give up. Many payors do not understand the nature of a post-acute practice or how your practice will improve care for patients in LTC without access to a traditional office. You can appeal to the payor and ask to continue the process by supplying proof of your worth: cost-efficiency, your efficacy, your productivity and quality of care, or anything else that will illustrate the value your practice provides.  

Pushing back at a closed panel might not always guarantee a positive outcome. Still, it’s worth a try, especially when you will provide significant value to the patient population.  

  1. Not tracking your applications through the payor review often or closely enough.  

Although the process of payor enrollment has seen few changes, the ongoing COVID-19 pandemic has certainly introduced new issues and delays that may catch you off-guard. One of the most significant issues with payor enrollment is the uncertainty in processing time.  

Many payors continue to have their workforce deployed in a remote work environment.  This has changed their decision-making infrastructure and has contributed to extended delays in application processing. Many payors are unable to provide, or adhere to, a published processing turnaround time. The best way to combat this is to regularly follow up with payors regarding application status and any missing paperwork.  

A dangerous pitfall for practices during this enrollment processing period is the failure to account for external factors and rely solely on past experiences to estimate a timeline. Even if you have been provided with an estimated turnaround time, unexpected events such as undelivered documents can completely throw off your plan.  

Onboarding new providers and enrolling them with payors is a complicated process that requires an overwhelming level of attention to details in preparing and following through with any application. Many LTPAC practices simply do not have the human resources to take care the enrollment process. Outsourcing to a dedicated partner is their best choice to ensure proper enrollment, bring in steady income and relieve your mind of the stressful administrative function.  

 

Saisystems is prepared to support your provider enrollment processing from start to finish while providing transparency and updates along the way. Get in touch with an enrollment expert now to learn how you can speed up your enrollment process, reduce internal costs and have a team with core skills in place.