INSURANCE: Payers

THIRD PARTY HEALTHCARE PAYERS

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Medical provider and doctor enrollment is an inevitable process that comes with running your own clinic or medical office. Becoming a health insurance company provider with top paying commercial and government insurance carriers is essential to maintaining steady patient referrals and cash flow and are the backbone of any successful clinic or practice.

For a normal practice today, you might see 15% to 25% of your patients through Medicaid depending on the population you serve and where you are located. After that, it is normally 7 or more commercial payers that will drive 70% or more of your patients to your practice. Now, consider that health insurance applications are completed in 25 to 50% of the time it takes when handled in-house, saving you on average at least 2 months of time and over 100 or more hours of work. Enrollment and contracts are setup right the first time to avoid these most common mistakes:

1. Starting Too Late

In ideal situations, you would want to begin the process at least 90 days prior to opening (with the exception of a provider already joining an existing practice).

For new start-up it can take at least 4 – 6 months to complete the entire process. Doing it on your own could take 8 – 12 months. Many practices simply cannot survive within that time frame.

2. Forgetting to include complete information

An insurance company needs a thorough picture of your current and past medical practice to determine if you would be a good fit for joining their provider network. The data required includes practice address, phone/fax number, contact information, services provided, copies of your license, employment history, average patient profile and any records of past legal troubles regarding your medical practice. Omitting any of the required data will lead to delayed processing by insurance carriers and even denials into the network as a participating provider.

3. Lack of Follow-Up

As mentioned above, the average provider enrollment/credentialing process can take months. Constant communication with the insurer will keep you up to date on your application’s status. Many insurers are understaffed and the process takes much longer than in the past and being proactive will help to shorten this waiting period in most cases.

HOW MAY WE SERVE YOU?

Contact: Ann Miller RN MHA CMP™ for all related engagement details:

Email: MarcinkoAdvisors@outlook.com

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