Dispelling Five Common Provider Enrollment and Credentialing Myths

Provider credentialing and enrollment are both complex and detailed processes. Unfortunately, this level of complexity has created room for a number of different myths to flourish. In this article, we’ll take a look at the five most common provider credentialing and enrollment myths in order to help ensure that your healthcare practice doesn’t follow faulty information when it comes time to perform these all-important processes.

Myth #1
The Credentialing and Enrollment Processes start after you hire a new physician

Far too many healthcare practices put the cart before the horse by hiring a physician and setting their start date before they begin the credentialing and enrollment process. While this is a common practice, it’s far better to start the credentialing and enrollment processes well before your new physician actually comes on board. Since credentialing a new provider and enrolling them with various insurance payers can often take several months to complete, bringing a new physician on board before these processes are complete can create a number of problems, including compliance issues, reimbursement money that is left on the table, and inconveniencing the provider and their patients.

Myth #2
Credentialing is not part of a Healthcare practice’s Revenue Cycle

There was a time not too long ago when this statement would have been true. In the past, the healthcare revenue cycle specifically referred to just payment collection and claims processing. Today, however, the term has been redefined to encompass a much broader set of processes, including provider credentialing. The Healthcare Financial Management Association and the Healthcare Information and Management Systems Society both currently define the healthcare revenue cycle as encompassing any clinical or administrative function that contributes to the capture, management, and collection of revenue from patients. Since credentialing a new provider begins the process of their ability to collect payments from patients, provider credentialing is now considered to be part of the healthcare revenue cycle.

Myth #3
There’s nothing that can be done if a Payer declines to enroll a new Provider

Having a payer reject your application to enroll a new provider in their insurance plan can certainly be a frustrating turn of events. However, it’s not the end of the road. To start, there is an appeals process that you can leverage to have your case reexamined. If this appeal is likewise rejected, a second-level appeal is also an option. If the appeal process doesn’t get you anywhere, you may still be able to negotiate terms and convince a payer to accept your provider through creative solutions such as offering an initial trial. None of this is guaranteed to work, but it is important to understand that having a payer reject your application is not the end of the line.

Myth #4
Payers will contact you if there is a mistake on your application

While it’s nice to believe that payers will take the time to reach out if there is a simple error on your application that is preventing it from being approved, this isn’t always the case. Instead, many payers will simply reject your application outright without offering any kind of explanation, forcing you to start the enrollment process over again from the beginning. With this being the case, it is essential to follow up with payers each time you submit a new form to ensure that they have received the form and that all required information on the form is present. While payers may not reach out to you if there is a mistake or missing form that is delaying your application’s approval, they typically will take the time to follow up if you are the one who reaches out to them.

Myth #5
You’re on your own

Most healthcare practices view provider credentialing and enrollment as a burden they have to bear alone. Today, however, this is no longer the case. In 2021, healthcare practices wading into the waters of provider enrollment and credentialing have a wide range of third-party services to choose from designed to alleviate many if not most of the responsibilities associated with provider enrollment and credentialing. At Bikham Healthcare, for instance, we proudly offer provider enrollment and credentialing services to healthcare practices all over the country. These services enable practices to offload all of the time-consuming hassles associated with credentialing and enrollment, freeing them up to focus on other vital tasks. If you find the processes of provider enrollment and credentialing to be too time-consuming and overwhelming to tackle on your own, understand that there is assistance available.

Let Bikham Healthcare help ensure Provider Credentialing and Enrollment Success

At Bikham Healthcare, we are all too familiar with the common myths associated with provider and enrollment credentialing due to the fact that we have seen these myths create problems for healthcare practices time and time again. Provider enrollment and credentialing are processes that certainly lend themselves to the potential for costly errors. When you choose to work with the credentialing and enrollment experts at Bikham Healthcare, though, you can look forward to avoiding such errors and completing these crucial processes in a way that is as efficient and successful as possible.To learn more about our industry-leading provider credentialing and enrollment services, be sure to contact us today. A friendly and knowledgeable customer service representative will be happy to answer any questions you might have and get you started enjoying the substantial benefits that our credentialing and enrollment services offer.