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Revenue Cycle Risks
Administrative responsibility and its role in billing The revenue cycle is the lifeblood of any practice. As more and more funders are increasing scrutiny of practices within their network, the burden of responsibility on a group’s administration is increased. Navigating the administrative side of a group healthcare practice can feel like a full-time job – particularly when it comes to the world of credentialing. It is critical to ensure that not only are your healthcare providers fully credentialed, but that their documentation is maintained even after joining the network. Compliance not only ensures that claims are paid correctly, but also ensures that a practice remains healthy in its record keeping and procedures. Credentialing is a multi-step process that can vary in length between funders. In order to stay ahead of the curve of a funder’s requirements it is best practice to keep dedicated folders for each provider with their relevant board certifications, licenses, work history, educational background, etc. Maintaining these minimizes delays as well as ensures a more organized transition into becoming an in-network provider. Even for providers who don’t typically require credentialing such as technicians or assistants, often some level of registration or roster keeping is required. What’s at stake? If a provider has not completed the credentialing and contracting process, any services rendered are not billable. We have seen groups attempt to add providers to a portal or website, not understanding that the credentialing process was not complete. In the world of ABA, multiple sessions per week add up quickly. We have seen practices with tens of thousands of dollars of claims that are not billable due to a misunderstanding of administrative requirements. Understanding what your payer’s credentialing process looks like can go a long way in preventing these issues. What is backdating? What are the risks? Backdating is the process of a funder registering an in-network provider as effective to render services at a date prior to the date their credentialing has been completed. We have seen many practices work under the assumption that insurance companies will backdate their enrollments. While many funders do allow for this practice, there are some that do not. Even in cases of funders that do allow this, oftentimes fee schedules, contracts, and even authorizations may not be appropriately loaded in their systems. This can be extremely frustrating as these delays are out of the control of the provider. While there are risks associated with backdating, it is best practice to decide what approach works best for your group. When choosing to backdate, remaining proactive can ensure that nothing is missed and that the insurance is maintaining your information appropriately. Coordination of benefits, plan changes, and internal delays with the funder can often turn minor mistakes into costly delays that can total in the tens of thousands of dollars. Documentation is key, and retaining any guarantee of backdating is necessary, particularly in writing if possible. Responsible administrative tips: If all this seems like a lot, or you just want to make sure it’s done right, CBC is here to help. Our team offers comprehensive credentialing services, revenue cycle management, and even consultation services, taking the weight off your shoulders so you can focus on what you do best—providing exceptional care. With CBC’s support, you can rest easy knowing your administrative needs are covered, leaving you free to focus on what really matters—your patients.
