New Provider Revenue Gap

The credentialing process is a critical step in getting a new provider set up to see patients and generate revenue for your practice. However, this process can be time-consuming and may take several months to complete. During this time, your new provider is not able to see patients or generate revenue, resulting in a significant financial impact on your practice. For example, if a new provider is expected to generate $10,000 per month in revenue, a 90-day delay in credentialing would result in a $30,000 revenue gap. To minimize this gap, it's essential to have an efficient credentialing process in place.

In our experience, one of the most significant delays in the credentialing process is the time it takes to gather all the necessary documentation from the provider. This can include items such as medical licenses, malpractice insurance, and board certification. To streamline this process, we recommend creating a checklist of all the necessary documents and having the provider complete it as soon as possible. We also recommend working closely with the provider to ensure that all the necessary documentation is submitted to the payers in a timely manner.

The credentialing process typically involves several key steps, including verifying the provider's credentials, submitting an application to the payers, and following up with the payers to ensure that the application is processed in a timely manner. One of the most critical steps in this process is verifying the provider's credentials, which includes checking their medical license, board certification, and malpractice insurance. This step is critical because it ensures that the provider is qualified to provide care to patients and that your practice is not at risk of being penalized for non-compliance.

To verify a provider's credentials, we recommend using a reputable credentialing verification service, such as the Council for Affordable Quality Healthcare (CAQH). This service allows providers to self-report their credentials and provides a standardized way of verifying credentials. We also recommend working closely with the provider to ensure that all the necessary documentation is submitted to the payers in a timely manner. For example, we recommend submitting the provider's application to the payers at least 60 days prior to the expected start date to allow sufficient time for processing.

Streamlining the billing process for new providers is critical to minimizing the new provider revenue gap. One of the most effective ways to do this is to have a comprehensive onboarding process in place that includes training on the billing system and policies. This training should include information on how to correctly code and bill for services, as well as how to handle denied claims and appeals. For example, we recommend providing new providers with a detailed guide on how to use the billing system, including how to submit claims and track payments.

In addition to providing comprehensive training, we also recommend implementing a system for tracking and following up on claims. This can include using a claims tracking software or assigning a staff member to follow up on claims on a regular basis. By streamlining the billing process, you can reduce the time it takes to get paid for services and minimize the financial impact of the new provider revenue gap. For example, we recommend using a system like Availity or Stedi to track claims and follow up with payers.