Provider enrollment & credentialing can be a long, challenging, and often error-prone process requiring a significant investment in time from your staff. Community Health Centers (CHCs) often struggle with this important function while trying to keep the process in-house. However, this highly specialized, full-time responsibility often falls to someone at your CHC with little or no experience or becomes a secondary responsibility for already busy human resources or billing teams. Either way, the risk to your bottom line is very real.

For those who cannot find the right internal staff or who have limited resources, hiring an outside firm to complete and maintain enrollment & payer credentialing may seem like a luxury, however, that is not always the case. Consider the fact that the ROI for the price of enrollment/payer credentialing service is usually equal to 10-12 paid visits for the newly enrolled provider. In other words, national UDS data shows CHCs make about $177 per visit. Only 10-12 visits paid equals $1,500- $1,800. Therefore, a service costing about this much money pays for itself within 10-12 visits. In truth, the peace of mind for getting it done right and in a timely manner is priceless.

So, if you are thinking about reaching out to credentialing firms to explore your options, here are five things to keep in mind throughout the process.

Community Health Center Experience is Critical

On the billing side of things, FQHCs and CHCs are unique… and this holds true when it comes to provider enrollment & credentialing.  It is so important to ask if prospective vendors have experience working directly with FQHCs and CHCs.  Do not be afraid to ask questions. Does the company understand the nuances and challenges that make FQHCs unique? Have they worked with submitting Medicare Part A and Part B applications?  Do they have a comprehensive understanding of state-specific payers and how to optimize the application process? Are they asking the right questions when speaking with payers to ensure that the enrollment is handled accurately for your CHC? If you are not satisfied with how they answer these questions, keep looking until you find a company that understands the distinct needs of an FQHC.

Find a Partner…Not Just a Vendor

Let’s consider the difference between a vendor and a partner.  A vendor is typically a company that offers a service or product for sale.

It is generally a simple relationship where the vendor provides a specific service in exchange for a specific amount of money.  Vendors will price themselves in lower margins because the relationships are more transactional and do not scale over time. 

Partners focus on having a meaningful impact on your business and on adding value.  They are subject matter experts and strategists that want to invest in long-term relationships with a focus on building trust and operating with transparency.  While you may have various staff members handling enrollment and credentialing today, a partner is an expert in this area.  They have experienced success and failures over the years and can share the benefit of their wisdom with their clients.

It is Tempting to Select the Lowest Priced Vendor…But be Careful

Did you find a firm that is far less expensive than others or is willing to offer you a significant discount? We mentioned earlier that credentialing is not easy, and we all know that recruiting and retaining well-trained employees costs money. So, you must wonder how these companies can maintain knowledgeable and experienced staff? As you review your options, 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.

Ongoing Communications Builds Trust

How important is it to you that you are kept in the loop by your provider enrollment and credentialing partner? Most FQHCs would answer, “very important.” Many clients come to us after an unsatisfying experience with a previous vendor who did not provide status updates regularly 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 Credentialing, we find that recurring conference calls with CHC clients provide transparency and help ensure that we meet and exceed their expectations.

Make sure that as part of your review process, you talk about how your reporting will work and if you will have access to a dedicated account manager as well as regularly scheduled meetings.

Specialty or Start-Up?

There are a good number of credentialing companies that have popped up across the country, many of them being small, specialty operations. 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 is not necessarily a deal-breaker you do need to be sure to ask for references, especially FQHC references. As we mentioned before, they must understand the unique challenges of the FQHC world.  The last thing you want to discover down the road is that they have no experience and are using your health center 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 receive the level of service you deserve.

In the end, you have to make the decision that makes the most sense both fiscally and operationally for your health center.  Making an investment in your enrollment and credentialing process today can have a significant impact on your revenue cycle tomorrow. Keeping these tips in mind will help give you some assurance that you are making the best decision for your FQHCs future success.