Inaccurate or incomplete third-party payer enrollment costs health centers money. Period. In this credentialing/enrollment column topics have included HRSA compliance, patient safety, OIG exclusion list monitoring, importance of keeping records current, etc. In the end, it’s never the money BUT it’s always the money.

The most recent year UDS data has the Blended Encounter Rate (BER) for health centers at a whopping $237.59. This is a more than $40 per visit bump from the preceding year. Here is the quick calculation for doubters or arithmetic luddites:

Total 2020 Payments =   $25,767,924,679

Total 2020 Visits/Encounters =  108,456,387

Payments ÷ Encounters (BER) = $237.59

Calendar year 2020 payments increased from 2019 by $4 Billion... that’s million but with a “B.” While, for the same period, visits/encounters went down by more than 3 million. It was COVID and lots of debate exists about allocated dollars and the future. AND, anyone can question much of the UDS data validity. However, it is indisputable that health centers’ top line income is higher than ever.

So, why bring this up here. Simple. Either your providers are appropriately enrolled to full participation status with Medicaid, Medicare, and all leading commercial payers in your market or you don’t get paid. Not just simple, stupid simple.

How much of your health center’s accounts receivable (AR) is tied up in “credentialing” issues? You need to know. Also, it is not just the individual providers that should cause concern. Each person reading this knows if an individual clinic location is not appropriately credentialed/enrolled... no one at that location can be paid. This primarily impacts Medicare but it can happen across other payers as well.

Remember, not all claims will be paid and AR is real. Avoid the truly avoidable AR issues. If credentialing and enrollment challenges are creating volumes of AR, contact a professional consultant or a team like PMG Credentialing to stop the madness. Be in touch today and see results in the very near term.