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Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
Newport Credentialing Solutions Capabilities Presentation
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Newport Credentialing Solutions Capabilities Presentation

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Newport Credentialing Solutions Capabilities Presentation

Newport Credentialing Solutions Capabilities Presentation

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  • 1. Re-­‐Defining  the  Physician  Creden4aling  Life  Cycle    Capabili(es  Presenta(on   1
  • 2. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Mission and Values Newport Credentialing Solutions is to be the nation’s premier provider of cloud based software and comprehensive services dedicated to the physician credentialing life cycle. Our values are: ✤  Listen to our client s challenges and needs ✤  Commitment to our client’s mission ✤  Develop innovative, solution driven software ✤  Relentless pursuit of Excellence ✤  Intense focus on Exceeding our client s expectations ✤  Teamwork ✤  Accountability confidential and proprietary presentation 2
  • 3. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions The Problem ✤  The Affordable Care Act (ACA) and the evolution of Accountable Care Organizations (ACOs) has forced hospitals to align themselves with physician groups at unprecedented rates ✤  Reimbursement rates are dropping ✤  Physicians are forced to deal with administrative tasks rather than practice medicine ✤  Administrative tasks fall through the cracks which negatively impacts revenue A 2003 AMA study concluded that healthcare organizations spend up to $1B per year on administrative costs related to credentialing management confidential and proprietary presentation 3
  • 4. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions The Result of The Problem ✤  Credentialing has historically never been viewed as a critical component of the revenue cycle ✤  Credentialing software programs, while valuable for hospital privileging, have completely ignored the provider enrollment side of credentialing. Failures include: ✤  Not understanding that revenue is tied to every enrollment ✤  Not understanding that processing times effect revenue ✤  Enrollment and Payer Performance benchmarks do not exist ✤  Real world, process driven workflow software does not exist ✤  Incredibly difficult to use and highly in-efficient ✤  The lack of focus on credentialing directly effects higher AR days, increased denials, non-par payments, customer service issues, and frustrated providers. If you are not enrolled correctly, you will not be paid correctly confidential and proprietary presentation 4
  • 5. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Why is Credentialing Management Costly and Inefficient? v  High Cost Overhead, Management and Staff Resources: (average skilled resource = $35-45K/year + Fringe) v  Lack of Standardization: Despite efforts by CAQH and other administrative bodies, insurance companies continue to request physician credentialing information in non-standard formats v  Processing Difficulties: ✤  Difficult to track down provider documentation and signatures ✤  Time intensive processing (numerous payers and lengthy applications (40-50 pages long) ✤  Complex: v  Difficult to correctly link PINs, TINs, Place of Service, and Pay to Addresses to specific groups, organizational contracts or fee schedules Studies have shown that the average provider completes 15 to 20 applications per year and spends 1 to 2 hours per application completing these forms. The time alone to credential one physician could be up to 40 hours.  confidential and proprietary presentation 5
  • 6. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Credentialing Economics (Initial Physician Credentialing) ✤  10 Doctors bill $10M annually ✤  5 additional doctors join an existing medical practice bringing the total number of doctors to 15 and billings to $15M ✤  $10M in billings results in $4M in annual collections. $15M in billings results in $6M in annual collections ✤  5 additional doctors will bring in an additional $2M in annual collections or $5,479 per day to the organization s bottom line Monthly Collections with 5 Additional Doctors in March 3 Month Credentialing vs. 6 Month Credentialing $600,000 Typical Credentialing timesMonthly Collections $500,000 are 180 days. $400,000 By decreasing your Days In $300,000 Enrollment by 90 days, your $200,000 practice could realize $100,000 incremental revenue of $- $493,110. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 3 Month Credentialing 6 Month Credentialing Months confidential and proprietary presentation 6
  • 7. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Credentialing Economics (Expirables Management) ✤  10 Doctors bill $10M annually over 10 payers ✤  Doctors collect $4M annually or $10,958 per day ✤  Doctors credentialing expires for two payers resulting in $2M of annual lost charges or $5,479 per day ✤  The typical re-credentialing process takes 180 days ✤  180 days of re-credentialing at $5,479 per day results in $986,220 in lost billable charges or $394,488 in lost collections ($2,191 per day) Monthly Collections after Expiration in March 3 Month Re-Credentialing vs. 6 Month Re-Credentialing Monthly Collections $350,000 $300,000 For every day your physicians $250,000 are not re-credentialed, your $200,000 practice may lose $5,479 in $150,000 $100,000 billable charges or $2,191 of $50,000 collections. $- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Continuous Re-Credentialing 6 Month Re-Credentialing Months confidential and proprietary presentation 7
  • 8. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Comprehensive Solutions Newport Credentialing Solutions is the nation’s premier provider of cloud based software and comprehensive services dedicated to the physician credentialing life cycle v  Comprehensive Physician Credentialing Services v  Complete Initial Enrollment v  Document Management v  Application Processing and Follow-up v  Expirables Management and Re-Credentialing Services v  Delegated Credentialing Management Services v  Cloud Based Workflow and Analytics Software - CARE v  Comprehensive v  Accounts v  Receivable v  Enrollment confidential and proprietary presentation 8
  • 9. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Comprehensive Credentialing and Expirables Management – ROI Newport s comprehensive credentialing and expirables management services increases efficiencies through centralization, reduces operating costs, and generates incremental revenue. Clients often see a 10 to 1 return on their investment for net new provider enrollments v  Increased Efficiencies Through Centralization v  Centralized Enterprise Management v  Faster Processing and Turn Around leading to incremental revenue v  Enterprise Reporting to drive accountability v  Reduced Operating Costs v  Re-allocation of staff to higher ROI functions (e.g., Front End Activities, AR Collections, etc.) v  Reduction of staff leading to increased bottom line revenue v  Incremental Revenue v  Quicker processing and turn around reduces payer processing time which directly translates to incremental revenue v  Providers are able to see and bill for patients sooner which directly translates to additional patient revenue v  Reduce provider salary outlay without return confidential and proprietary presentation 9
  • 10. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Experience v  Radiology v  Social Workers v  Nutrition v  Pathology v  Certified Nurse Mid- v  Speech Pathology v  Dermatology Wives v  Audiology v  Internal Medicine v  Emergency Medicine v  Physical Therapy v  Gastroenterology v  Hospitalists v  Physical Medicine andv  OB/GYN v  Family Medicine Rehab v  Pediatrics v  Hematology v  Pain Management v  Surgery v  Oncology v  Anesthesiology v  Cardiology v  Neurology v  Certified Registeredv  Neonatology v  Orthopedics Nurse Anesthetistsv  Allergy and v  Sleep Medicine (CRNAs) Immunology v  Sports Medicine v  Chiropractors v  Infectious Disease v  Urology v  Critical Care Medicine v  Psychiatry v  Endocrinology v  Optometry v  Psychology v  Geriatric Medicine v  Ophthalmology v  Dentistry v  Nephrology v  Occupational Therapy v  Physician Assistant v  Nuclear Medicine v  Nurse Practitioner v  Otolaryngology confidential and proprietary presentation 10
  • 11. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Comprehensive Credentialing Services Newport s Comprehensive Credentialing Services willmanage every aspect of your new physiciancredentialing. Services include: ✤  Complete and Pro-Active management of all new physician credentialing ✤  On-site collection of primary source documentation ✤  Rapid Data Entry ✤  Quality Assurance to ensure accuracy ✤  Packaging of all paper applications ✤  Work with the client to obtain physician signatures ✤  Expedited mailing to payers for processing ✤  Management of delegated credentialing rosters confidential and proprietary presentation 11
  • 12. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Document Management All primary source documentation is centralized and electronically stored on our advanced credentialing workflow software. Clients may have access to their primary source documentation 24/7. Demographic and Practice Information Training Board Certification General Information Education References Work History Insurance Current and/or Prior Licensure Liability Coverage Attestation Affiliations Attachments confidential and proprietary presentation 12
  • 13. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Application Follow-Up Newport believes that Application Follow-upshould be handled just like AR Follow-up: ✤  Rigorous ✤  Systematic ✤  Standardized Newport checks the following: ✤  The application was received ✤  The payer is actively processing the application ✤  That all processing data requirements have been fulfilled ✤  Identify estimated payer completion date confidential and proprietary presentation 13
  • 14. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Re-Enrollment and Expirables Management Newport will manage your physician’s credentialingto ensure that there is no lapse in credentials.Expirables management includes: ✤  Pro-actively monitoring document expiration (e.g., licenses, DEA registration, board certification and professional liability insurance) using our easy to use expirables management reminder system ✤  Manage all re-credentialing activities ✤  Process all CAQH re-attestations (every 120 days) ✤  Pro-active dialogue between Newport and client s billing department/vendor confidential and proprietary presentation 14
  • 15. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Delegated Credentialing Management Our credentialing specialists mange thecomplex processes related to delegatedcredentialing for numerous clients. Ourservices include: ✤  Managing various submission formats for all delegated payers ✤  Managing weekly/monthly delegated credentialing updates with all payers ✤  Proprietary workflow software designed to easily update and monitor delegated spreadsheet formats confidential and proprietary presentation 15
  • 16. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Education Newport understands that: EDUCATION = ADHERENCE As such, Newport provides both on-site and webtraining sessions for all physicians. EducationalTopics include: ✤  What is credentialing and why is it important? ✤  How often does it occur? ✤  How will this effect me and how much time will this take away from my patients? ✤  What will I need to do to be compliant? confidential and proprietary presentation 16
  • 17. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Cloud Based Workflow and Analytics Software Newport understands that credentialing is often viewed as a black hole in manyorganization s revenue cycles. Existing in the middle of Front End and Back End operations, credentialing is often overlooked as a critical component of the revenue cycle. Credentialing Data = Revenue Newport has developed proprietary, cloud based workflow and decision support softwareto help drive critical financial, operational, and process decisions. The following slides depict some images of the patent pending software that we provide our clients. confidential and proprietary presentation 17
  • 18. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions CAREreport – Institutional Summary Blocked Out, Blocked Out , Blocked Out, Blocked Out confidential and proprietary presentation 18
  • 19. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions CAREreport – Facility Summary confidential and proprietary presentation 19
  • 20. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions CAREreport – Trend Summary confidential and proprietary presentation 20
  • 21. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle CAREreport – Department Summary confidential and proprietary presentation 21
  • 22. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions CAREreport - Provider Summary confidential and proprietary presentation 22
  • 23. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions CAREreport - Provider Summary - Aging confidential and proprietary presentation 23
  • 24. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions CARElist - Dashboard confidential and proprietary presentation 24
  • 25. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions CARElist - Worklist confidential and proprietary presentation 25
  • 26. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions CARElist - Worklist confidential and proprietary presentation 26
  • 27. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Summary of Services v  Comprehensive Credentialing Services with Minimum Interruption to Organizational Management and Staff v  Expirables Management Services v  Re-Credentialing Services v  Delegated Credentialing Management Services v  Cloud Based Workflow and Analytics Software - CARE v  Comprehensive v  Accounts v  Receivable v  Enrollment confidential and proprietary presentation 27
  • 28. Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle Charting Physician Credentialing Solutions Contact Information ✤  Address: 241 Rockaway Ave, Suite 102 Valley Stream, NY 11580 ✤  Phone: 516.593.1380 ✤  Fax: 516.566.2375 ✤  Email: info@newportcredentialing.com ✤  www.newportcredentialing.com confidential and proprietary presentation 28

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