RCM tip of the day: Don’t underestimate the importance of participating and nonparticipating analysis

As hospitals seek to maximize revenue, it is crucial they conduct a participating and nonparticipating analysis to ensure their provider enrollment data corresponds to the enrollment data that the payers have recorded, according to Patrick Doyle, senior vice president of Lynbrook, N.Y.-based Newport Credentialing Solutions.

Advertisement

Mr. Doyle shared the following tip with Becker’s Hospital Review: “If a provider is not properly enrolled, they will not get paid. A participating and nonparticipating analysis is the process of validating the participating status of each provider across all plans, locations and tax IDs. This analysis is critically important in that it creates a baseline of who your providers are enrolled accurately with — and who they are not. By establishing an enrollment baseline and identifying which providers are not enrolled with your plans, you can take proactive steps to enroll them correctly to avoid lost revenue.”

Read more about provider enrollment here.

 

More articles on healthcare finance:
Massena Memorial CFO blames employee insurance claims for net loss in June
HRSA awards WSU College of Nursing $1.3M to expand NP program
Montana health department proposes nearly 3.5% cut to Medicaid reimbursement

Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit

Advertisement

Next Up in Financial Management

Advertisement

Comments are closed.