Community Health Centers (CHCs) often struggle with credentialing and provider enrollment. Trying to keep the process in-house means finding (and keeping) experienced staff. Too often this full-time job defaults to someone at the CHC with little or no experience, becoming an annoying secondary responsibility for human resources or the billing team. Since getting your providers billable ASAP is vital to your bottom line, many CHCs turn to an outside vendor. Buyers beware! If your CHC is looking for a credentialing firm here are four important considerations.
Must Have Community Health Center Experience
Just like billing, CHCs are a different animal when it comes to provider enrollment. It is so important to ask if your vendors have CHC experience. Don’t be afraid to ask questions. Does the vendor understand nuances/pitfalls that come along with being a CHC? Have they worked with submitting Medicare Part A and Part B applications? Have they helped centers open new locations in the past? Are they asking the right questions when speaking with payers to ensure that the enrollment is handled accurately for your CHC? There are plenty of vendors out there. Keep looking until you find one who understands the unique needs of a CHC.
Ongoing Communications Builds Trust
How important is it to you that you are kept in the loop by your provider enrollment and credentialing vendor? Most CHCs would say very. Many clients come to us after an unsatisfying experience with a previous vendor who didn’t provide status updates on a recurring basis or at all. They thought everything was being handled when in reality; the work was falling by the wayside. Find out what kind of reports the vendor provides and how often they provide these reports. At PMG we find that recurring conference calls with CHC clients provides transparency and helps ensure that we meet and exceed their expectations.
Be Suspicious of Deep Discounts
Did you find a firm that is far cheaper than others or willing to offer you a huge price break? “You get what you pay for,” is important to remember when selecting a vendor. Any company willing to beat all competitor prices should raise a red flag. We mentioned earlier that credentialing is not easy, securing well-trained employees costs money so you have to wonder how these companies willing to undercut prices are maintaining knowledgeable and experienced staff. There is also no need to go with the extreme opposite end of the pricing spectrum either. You should consider the cost of internal staffing, as well as revenue, lost when your providers are not properly enrolled with payers. Your billing department should be able to provide you with a report showing enrollment related denials. In the end, selecting a vendor for your provider enrollment needs should make financial sense for your CHC.
Boutique or Beware?
We have noticed ‘boutique’ credentialing services popping up all over the map. The concept seems so appealing, a small firm that promises that YOU are their only client and they do not take on more work than what they can manage. While a small firm isn’t necessarily a deal breaker you do need to be sure to ask for references, especially CHC references. You don’t want to find out down the road that they have no past experience and are using your account to learn the business. You also need to certify that they can handle the volume of work necessary at your CHC. You should inquire about the size of their other clients, the number of staff assigned to each account, and what guarantees they offer to ensure you are not lost in the mix if they get overwhelmed.