How Does Credentialing Impact RCM? Three Questions with Newport’s CEO Scott Friesen
As reimbursement is shifting from a fee-for-service to a value-based model, and as hospitals are embracing population health management and risk-based-contracts to meet these new payment requirements, there has been a tremendous aggregation of employed providers in the market, Mr. Friesen says. Therefore, hospitals have had to apply increased resources to make sure all of their newly employed providers are enrolled correctly with their insurance payers.
“So within the revenue cycle, it’s become incredibly important for hospitals to not only ensure that their providers are enrolled with all of their insurance plans, so they are paid correctly, but now, they also have to be able to track, from an enrollment perspective, where and when their providers performed clinical services based on each risk-based contract they participate with. The bottom line is that if hospitals don’t manage their provider’s enrollment within these risk-based contracts correctly, they risk not getting paid, or getting paid out-of-network,” he added.
Newport offers cloud-based software that clients can license to manage their enrollment themselves, or the company offers outsourced services where clients can have Newport manage the entire credentialing life cycle for them on their organization’s behalf.
Mr. Friesen spoke with Becker’s Hospital Review about why provider enrollment is important and how Newport addresses it.
Read the article in Beckers Healthcare.
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