The Impact of Credentialing on Cash Flow

prescription medications and moneyLet’s rewind about four years to 2010 where physicians thought they had until January 2011 to comply with Medicare PECOS enrollment, but they found out otherwise. It was in May 2010 that it was announced by Medicare that the health system reform law created a new mandate that moved the deadline up six months. As of July 6, 2010, cash flow would be interrupted for those physicians receiving referrals from other physicians not enrolled in the Provider Enrollment Chain and Ownership System (PECOS). If a claim was submitted to Medicare after the July date with a referring physician not enrolled in the system, then Medicare could reject the claim.

This is something that is still in effect. If the proper Medicare credentialing is not in place, money could be lost, which would create some pretty significant issues. This essentially means that practices need to work with the referring provider base and ensure that the referring providers are enrolled in PECOS. If they are not, then it may be time to cut ties with that referring provider until they are in order to avoid losses.

If you are that provider, then it is imperative that you receive your Medicare credentialing as soon as possible so that you and any physicians that you refer to do not lose revenue. The end result is a burden that is higher than the more typical billing situation, which is when a provider only needs to ensure that he or she is properly enrolled with a particular payer.

Mitigating the Risk to Your Cash Flow

You can mitigate the risk to your cash flow by advising refers that they need to engage in Medicare provider enrollment or enroll yourself if you are not. Here are ways you can lower the risk to your cash flow:

•    Generate a report that consists of your top referring physicians and other providers.
•    Call the PECOS system and check to make sure that the key referrers to your practice are enrolled as they should be. In order to do this, you will need basic information about the providers, such as their provider ID and their tax ID.
•    Contact the referring providers that are not enrolled and tell them that they need to move forward with PECOS Medicare enrollment. They need to know that they are not enrolled and why it is very important that they do enroll. They can be advised on how to enroll quickly with PECOS so that any delays in finalizing enrollment can be avoided.
•    If a provider is already enrolled with PECOS, it can be quite nice to send them thank you notes for doing so. This is a fantastic way of showing them how much their referrals are valued by your practice. When referring physicians feel valued, they will continue to make referrals.

While it is rare to find a physician that is not enrolled since it is required, there are new practices working on getting established. If they are not enrolled, then they will miss out on referrals and even hurt their own bottom lines. It is not just the physicians receiving the referrals that lose. If a physician finds out that another has not completed their enrollment for one reason or another, then they will not opt into receiving referrals from that physician. This could cause patients to not go to a doctor that cannot refer them to a specific doctor. While it can be difficult to quantify the impact to the referring physician, there is undoubtedly a negative effect at some point.

Ensure Your Cash Flow

To better ensure your cash flow, you can work with consultants that specialize in credentialing. This will ensure that you are properly enrolled in everything that you need to be enrolled in so you can ensure your bottom line. The physicians that did miss the PECOS Medicare enrollment deadline in 2010 found that the 21% Medicare fee cut was just one of the two major reimbursement problems that came about. With so much to keep track of, one of the last things that physicians need to worry about in regards to revenue is issues with reimbursement. If you don’t have to worry about it, you are able to focus on other important matters.

Credentialing is important to ensuring everything you are entitled to. At MD Pro Solutions, we can help you. To learn more, call us at 508-946-1665 or fill out our contact form and someone from our office will contact you.