This document discusses challenges with the traditional physician credentialing process and proposes a new approach. It notes that credentialing is costly and inefficient due to a lack of standardization, complex paperwork, and long processing times. This negatively impacts revenue by delaying provider enrollments and payments. The document proposes that streamlining credentialing using new software could save significant administrative costs and more quickly enroll new providers, boosting revenue by getting them paid sooner. Faster credentialing times could result in hundreds of thousands of dollars in additional monthly collections for a practice.
The document summarizes the keynote presentation by David Andrick and Adrian Byrne at the 2012 OHA Annual Conference on physician recruitment and employment. [1] Physician services departments need a formal due diligence process to ensure the right fit with physicians. [2] Building employed physician groups requires sensitivity to meet community needs while supporting hospital objectives. [3] Some local physicians may seek employment or joint arrangements due to reimbursement pressures and changing healthcare models.
The document discusses Insource Healthcare Solutions, a company focused on improving healthcare delivery and operations. It provides strategic solutions to healthcare clients, working with physicians and other medical professionals. The company aims to enhance quality, processes, and clinical excellence for each client.
Developing Employment Agreement for Quality, Operational Efficiency and Patie...Curtis Bernstein
This document discusses developing employment agreements for physicians that comply with regulations while improving quality and efficiency. It recommends tying physician compensation to productivity, quality metrics, and operational goals. Specific incentives are suggested around quality measures, operational improvements, and medical directorships. Fair market value benchmarks are important to consider to comply with Stark and anti-kickback laws.
The document discusses value stream management in healthcare. It defines a value stream as all the activities involved in treating patients from arrival to discharge. It describes mapping value streams using current and future state value stream maps to identify waste and improvements. The goal is to link processes in a smooth continuous flow without interruptions. Key components of value stream management include selecting a value stream manager, using visual controls, and conducting real-time problem solving and continuous process improvement.
Decosimo's Shannon Farr and Anderson Busby's Amanda Busby co-presented this PowerPoint at the 2012 Tennessee Bar Association's Health Law Primer on October 3, 2012 in Brentwood, TN.
The document discusses the nursing process and its key components. It describes the 5 steps - assessment, diagnosis, planning, implementation, and evaluation. Assessment involves collecting both subjective and objective data through various methods like observation, interviewing, and examination. Nursing diagnoses are formulated by analyzing the collected data and can take several formats with variations. The diagnosis statement identifies the problem, etiology, and defining characteristics. The nursing process is then used to develop an individualized care plan and carry out interventions to address the identified problems and goals.
The document discusses the importance of data collection for care management programs and outlines the Camden Coalition of Healthcare Providers' process for collecting and using data. Some key points:
1. CCHP collects data at multiple touchpoints during a patient's enrollment and over time to evaluate outcomes like stabilizing patients, coordinating care, improving health, and reducing costs.
2. Data is collected through tools like risk stratification tools, intake forms, client tracking forms, and surveys administered during enrollment, home visits, graduation, and follow-ups.
3. Collected data is compiled into reports and discussed to evaluate the program, identify areas for improvement, and determine if patients have met graduation criteria.
This document outlines an orientation for a dentist office introducing in-house dental specialties. It includes an agenda for the orientation covering introductions, training sessions for different staff roles, and a discussion on comprehensive dentistry and the benefits of an in-house specialty model. The benefits highlighted are providing comprehensive treatment for patients, increasing patient satisfaction by keeping them within the familiar dentist office, and simplifying communication and coordination between general dentists and specialists.
The document summarizes the keynote presentation by David Andrick and Adrian Byrne at the 2012 OHA Annual Conference on physician recruitment and employment. [1] Physician services departments need a formal due diligence process to ensure the right fit with physicians. [2] Building employed physician groups requires sensitivity to meet community needs while supporting hospital objectives. [3] Some local physicians may seek employment or joint arrangements due to reimbursement pressures and changing healthcare models.
The document discusses Insource Healthcare Solutions, a company focused on improving healthcare delivery and operations. It provides strategic solutions to healthcare clients, working with physicians and other medical professionals. The company aims to enhance quality, processes, and clinical excellence for each client.
Developing Employment Agreement for Quality, Operational Efficiency and Patie...Curtis Bernstein
This document discusses developing employment agreements for physicians that comply with regulations while improving quality and efficiency. It recommends tying physician compensation to productivity, quality metrics, and operational goals. Specific incentives are suggested around quality measures, operational improvements, and medical directorships. Fair market value benchmarks are important to consider to comply with Stark and anti-kickback laws.
The document discusses value stream management in healthcare. It defines a value stream as all the activities involved in treating patients from arrival to discharge. It describes mapping value streams using current and future state value stream maps to identify waste and improvements. The goal is to link processes in a smooth continuous flow without interruptions. Key components of value stream management include selecting a value stream manager, using visual controls, and conducting real-time problem solving and continuous process improvement.
Decosimo's Shannon Farr and Anderson Busby's Amanda Busby co-presented this PowerPoint at the 2012 Tennessee Bar Association's Health Law Primer on October 3, 2012 in Brentwood, TN.
The document discusses the nursing process and its key components. It describes the 5 steps - assessment, diagnosis, planning, implementation, and evaluation. Assessment involves collecting both subjective and objective data through various methods like observation, interviewing, and examination. Nursing diagnoses are formulated by analyzing the collected data and can take several formats with variations. The diagnosis statement identifies the problem, etiology, and defining characteristics. The nursing process is then used to develop an individualized care plan and carry out interventions to address the identified problems and goals.
The document discusses the importance of data collection for care management programs and outlines the Camden Coalition of Healthcare Providers' process for collecting and using data. Some key points:
1. CCHP collects data at multiple touchpoints during a patient's enrollment and over time to evaluate outcomes like stabilizing patients, coordinating care, improving health, and reducing costs.
2. Data is collected through tools like risk stratification tools, intake forms, client tracking forms, and surveys administered during enrollment, home visits, graduation, and follow-ups.
3. Collected data is compiled into reports and discussed to evaluate the program, identify areas for improvement, and determine if patients have met graduation criteria.
This document outlines an orientation for a dentist office introducing in-house dental specialties. It includes an agenda for the orientation covering introductions, training sessions for different staff roles, and a discussion on comprehensive dentistry and the benefits of an in-house specialty model. The benefits highlighted are providing comprehensive treatment for patients, increasing patient satisfaction by keeping them within the familiar dentist office, and simplifying communication and coordination between general dentists and specialists.
The document summarizes exploratory research conducted to redesign primary care systems. Key findings include:
1) The appointment process and doctor visits involve repetitive steps and unused waiting times for patients and staff.
2) Patients value time with their doctor most but it is the shortest part of the process.
3) Support systems that store patient information are underutilized, and patients are disconnected from these resources.
The research examines patient experiences and workflows through staff shadowing, surveys, and comparing systems in other countries to identify areas for more efficient design.
This document summarizes challenges facing Canadian hospitals regarding bed management capacity. It discusses how one health system in Hamilton, Ontario responded to issues of improving clinical services, defining quality standards, and achieving financial benchmarks. The response included recentralizing housekeeping and patient transport, beginning a bed management program, and transforming the service culture. As a result, the health system saw standardized, satisfactory service levels; $2 million in annual cost reductions; and a 30% drop in employee absenteeism. It proposes further integrating clinical areas and implementing electronic systems to continue progress.
The document discusses the challenges dental practices face with dental insurance, including limited information from insurance companies, preauthorizations only being issued to patients, and slow or partial payments. It provides strategies for dental practices to effectively manage dental insurance, such as educating patients on their responsibilities and utilizing forms and letters to inform patients of office policies. The entire dental team must be supportive of the practice's philosophy and approach regarding dental insurance.
Wheaton Franciscan Healthcare partnered with Convergent Revenue Cycle Management to improve self-pay collections and patient satisfaction. Convergent more than tripled Wheaton's self-pay collections rates and reduced wait times on phone calls from 20 minutes to 30 seconds. Convergent took over all aspects of Wheaton's accounts receivable management for self-pay balances, allowing Wheaton to focus on other areas while Convergent ensured high quality customer service and collections performance. The partnership has helped Wheaton generate additional revenue and reduce expenses compared to handling collections in-house.
This study evaluated the outcomes of a pharmacist-provided diabetes medication therapy management program (MTMP) sponsored by an employer for its employees and dependents. The study found:
1) Patients experienced improved clinical outcomes including reductions in A1c, blood pressure, and hospitalizations/ER visits.
2) Economic outcomes improved with reductions in costs of physician visits, hospitalizations, and ER visits.
3) Humanistic outcomes were positive with high patient satisfaction and improved disease knowledge retention over 6 months.
The MTMP resulted in overall improved health, quality of life and cost savings for participants.
This document provides guidance for local government units in the Philippines on establishing Standard Days Method (SDM) services. SDM is a natural family planning method that uses cycle beads to identify the fertile window each month. The document discusses assessing community need for SDM, setting up required facilities and supplies, establishing client flow processes, and considering clinic location and hours to ensure accessibility. The goal is to help more local areas provide this additional natural family planning option to those seeking it.
Quality assurance of rsby empanelled hospitals ppt for tvm1K Madan Gopal
The document discusses a pilot program to introduce a quality management system for hospitals empaneled under the Rashtriya Swasthya Bima Yojana (RSBY) health insurance scheme in Kerala, India. Over 4 years, 28.1 lakh families (54 lakh people) have been covered under RSBY through 353 empaneled public and private hospitals. The pilot program aims to grade hospitals on a scale of E to A based on criteria covering infrastructure, services, management, and patient care. Hospitals in Thiruvananthapuram district will be initially assessed and graded in order to encourage continuous quality improvement over time.
This document discusses several initiatives relevant to multiple sclerosis (MS) in the UK, including:
- The Department of Health Risk Sharing Scheme which provides access to disease-modifying therapies on the NHS and has shown positive results in clinical trials.
- Current developments in MS-related UK policy including guidelines under review and technology appraisals by NICE.
- Evidence that MS specialist nurses improve outcomes, provide complex care, and reduce costs through activities like avoided hospitalizations. However, they struggle to demonstrate their value to managers and commissioners.
- Challenges nurses face in justifying their roles and services as the NHS aims to make 4% annual efficiency savings through job cuts and other measures
BrightStar offers private duty home care programs like HANDS and Clinical Pathways to reduce hospital readmissions and improve quality of life. HANDS provides home care after discharge to address issues that arise. Clinical Pathways is a condition-specific, transitional care program focused on reducing negative outcomes and optimizing quality of life through RN visits, education, and monitoring. These programs aim to address the top reasons for readmissions like medication management and lack of home support. They utilize technology, evidence-based practices, and specially trained staff to benefit patients, healthcare systems, and providers through better outcomes and efficiencies.
10 Ways to Ensure Optimal Management of Your Practicerweymier
This document provides 10 ways for physicians to ensure optimal management of their medical practice. It discusses the importance of:
1) Billing, collecting, and managing accounts receivable efficiently by billing daily, using electronic filing, and auditing claims.
2) Proactively managing relationships with insurance payers by organizing contracts, monitoring payer performance, and negotiating renewals in advance.
3) Investing in staff by providing training, clear job descriptions, and collaboration to improve performance and patient experience.
The document outlines different components of a patient care flow for chronic pain treatment, including electronic health records, fluid synchronization pumps and services, hospitals that provide treatment, and pain clinics. It also shows the related value chain, with CPT reimbursement for the pump and surgical kit, hospital reimbursement, and the company Fluid Synchrony that provides the product and services.
an empirical approach for provider organizations transitioning during healthcare reform implementation, integrating clinical and financial historical experiences. The presentation, Challenge & Response -- delineates the discovery process within experiential databasesA
Looking to enhance your healthcare provider credentialing process? Our team of experts can help you effectively manage licenses and certifications. Focus on delivering superior patient care while we handle the rest.
Mastering Medical Credentialing The Essential Role Of Physician Credentialing...MedLifeMBS
In the intricate realm of healthcare administration, physician credentialing services stand as a cornerstone for ensuring the quality, credibility, and regulatory compliance of medical practitioners. From verifying credentials to facilitating provider enrollment, these services play a vital role in the seamless integration of healthcare professionals into the healthcare system. In this article, we delve into the importance of physician credentialing services, exploring their key functions, benefits, and best practices.
Efficient revenue cycle management is critical for the financial success of healthcare organizations. By outsourcing revenue cycle management, healthcare providers can benefit from the expertise and experience of service providers who specialize in optimizing processes such as medical credentialing services and medical coding audit services.
The document discusses strategies for improving patient flow and reducing cycle times in medical practices. It describes how mapping patient flows, measuring cycle times, and identifying interruptions can help practices pinpoint bottlenecks. Practices have found that small tests of change focused on areas like visit planning, co-locating staff, efficient office design, exam room standardization, documentation shortcuts, and streamlined check-in/out processes can uncover hidden capacity and increase revenue. The key is developing a deep understanding of the current process from the patient's perspective before envisioning an ideal flow and implementing changes while monitoring for unintended consequences. Physician leadership and a team effort are essential to successfully redirecting patient flow.
a part of "The Path Forward for Academic Medical Centers: Innovation", Economics and Better Health, an Economic Studies and Engelberg Center for Health Care Reform event at the Brookings Institutuion
Looking to boost your professional credentials as a healthcare provider? We've got you covered! 🌟 Let our expert team handle all your credentialing needs and take your career to new heights. #CredentialingServices #HealthcareProviders
The document summarizes exploratory research conducted to redesign primary care systems. Key findings include:
1) The appointment process and doctor visits involve repetitive steps and unused waiting times for patients and staff.
2) Patients value time with their doctor most but it is the shortest part of the process.
3) Support systems that store patient information are underutilized, and patients are disconnected from these resources.
The research examines patient experiences and workflows through staff shadowing, surveys, and comparing systems in other countries to identify areas for more efficient design.
This document summarizes challenges facing Canadian hospitals regarding bed management capacity. It discusses how one health system in Hamilton, Ontario responded to issues of improving clinical services, defining quality standards, and achieving financial benchmarks. The response included recentralizing housekeeping and patient transport, beginning a bed management program, and transforming the service culture. As a result, the health system saw standardized, satisfactory service levels; $2 million in annual cost reductions; and a 30% drop in employee absenteeism. It proposes further integrating clinical areas and implementing electronic systems to continue progress.
The document discusses the challenges dental practices face with dental insurance, including limited information from insurance companies, preauthorizations only being issued to patients, and slow or partial payments. It provides strategies for dental practices to effectively manage dental insurance, such as educating patients on their responsibilities and utilizing forms and letters to inform patients of office policies. The entire dental team must be supportive of the practice's philosophy and approach regarding dental insurance.
Wheaton Franciscan Healthcare partnered with Convergent Revenue Cycle Management to improve self-pay collections and patient satisfaction. Convergent more than tripled Wheaton's self-pay collections rates and reduced wait times on phone calls from 20 minutes to 30 seconds. Convergent took over all aspects of Wheaton's accounts receivable management for self-pay balances, allowing Wheaton to focus on other areas while Convergent ensured high quality customer service and collections performance. The partnership has helped Wheaton generate additional revenue and reduce expenses compared to handling collections in-house.
This study evaluated the outcomes of a pharmacist-provided diabetes medication therapy management program (MTMP) sponsored by an employer for its employees and dependents. The study found:
1) Patients experienced improved clinical outcomes including reductions in A1c, blood pressure, and hospitalizations/ER visits.
2) Economic outcomes improved with reductions in costs of physician visits, hospitalizations, and ER visits.
3) Humanistic outcomes were positive with high patient satisfaction and improved disease knowledge retention over 6 months.
The MTMP resulted in overall improved health, quality of life and cost savings for participants.
This document provides guidance for local government units in the Philippines on establishing Standard Days Method (SDM) services. SDM is a natural family planning method that uses cycle beads to identify the fertile window each month. The document discusses assessing community need for SDM, setting up required facilities and supplies, establishing client flow processes, and considering clinic location and hours to ensure accessibility. The goal is to help more local areas provide this additional natural family planning option to those seeking it.
Quality assurance of rsby empanelled hospitals ppt for tvm1K Madan Gopal
The document discusses a pilot program to introduce a quality management system for hospitals empaneled under the Rashtriya Swasthya Bima Yojana (RSBY) health insurance scheme in Kerala, India. Over 4 years, 28.1 lakh families (54 lakh people) have been covered under RSBY through 353 empaneled public and private hospitals. The pilot program aims to grade hospitals on a scale of E to A based on criteria covering infrastructure, services, management, and patient care. Hospitals in Thiruvananthapuram district will be initially assessed and graded in order to encourage continuous quality improvement over time.
This document discusses several initiatives relevant to multiple sclerosis (MS) in the UK, including:
- The Department of Health Risk Sharing Scheme which provides access to disease-modifying therapies on the NHS and has shown positive results in clinical trials.
- Current developments in MS-related UK policy including guidelines under review and technology appraisals by NICE.
- Evidence that MS specialist nurses improve outcomes, provide complex care, and reduce costs through activities like avoided hospitalizations. However, they struggle to demonstrate their value to managers and commissioners.
- Challenges nurses face in justifying their roles and services as the NHS aims to make 4% annual efficiency savings through job cuts and other measures
BrightStar offers private duty home care programs like HANDS and Clinical Pathways to reduce hospital readmissions and improve quality of life. HANDS provides home care after discharge to address issues that arise. Clinical Pathways is a condition-specific, transitional care program focused on reducing negative outcomes and optimizing quality of life through RN visits, education, and monitoring. These programs aim to address the top reasons for readmissions like medication management and lack of home support. They utilize technology, evidence-based practices, and specially trained staff to benefit patients, healthcare systems, and providers through better outcomes and efficiencies.
10 Ways to Ensure Optimal Management of Your Practicerweymier
This document provides 10 ways for physicians to ensure optimal management of their medical practice. It discusses the importance of:
1) Billing, collecting, and managing accounts receivable efficiently by billing daily, using electronic filing, and auditing claims.
2) Proactively managing relationships with insurance payers by organizing contracts, monitoring payer performance, and negotiating renewals in advance.
3) Investing in staff by providing training, clear job descriptions, and collaboration to improve performance and patient experience.
The document outlines different components of a patient care flow for chronic pain treatment, including electronic health records, fluid synchronization pumps and services, hospitals that provide treatment, and pain clinics. It also shows the related value chain, with CPT reimbursement for the pump and surgical kit, hospital reimbursement, and the company Fluid Synchrony that provides the product and services.
an empirical approach for provider organizations transitioning during healthcare reform implementation, integrating clinical and financial historical experiences. The presentation, Challenge & Response -- delineates the discovery process within experiential databasesA
Looking to enhance your healthcare provider credentialing process? Our team of experts can help you effectively manage licenses and certifications. Focus on delivering superior patient care while we handle the rest.
Mastering Medical Credentialing The Essential Role Of Physician Credentialing...MedLifeMBS
In the intricate realm of healthcare administration, physician credentialing services stand as a cornerstone for ensuring the quality, credibility, and regulatory compliance of medical practitioners. From verifying credentials to facilitating provider enrollment, these services play a vital role in the seamless integration of healthcare professionals into the healthcare system. In this article, we delve into the importance of physician credentialing services, exploring their key functions, benefits, and best practices.
Efficient revenue cycle management is critical for the financial success of healthcare organizations. By outsourcing revenue cycle management, healthcare providers can benefit from the expertise and experience of service providers who specialize in optimizing processes such as medical credentialing services and medical coding audit services.
The document discusses strategies for improving patient flow and reducing cycle times in medical practices. It describes how mapping patient flows, measuring cycle times, and identifying interruptions can help practices pinpoint bottlenecks. Practices have found that small tests of change focused on areas like visit planning, co-locating staff, efficient office design, exam room standardization, documentation shortcuts, and streamlined check-in/out processes can uncover hidden capacity and increase revenue. The key is developing a deep understanding of the current process from the patient's perspective before envisioning an ideal flow and implementing changes while monitoring for unintended consequences. Physician leadership and a team effort are essential to successfully redirecting patient flow.
a part of "The Path Forward for Academic Medical Centers: Innovation", Economics and Better Health, an Economic Studies and Engelberg Center for Health Care Reform event at the Brookings Institutuion
Looking to boost your professional credentials as a healthcare provider? We've got you covered! 🌟 Let our expert team handle all your credentialing needs and take your career to new heights. #CredentialingServices #HealthcareProviders
Grow Your Medical Practice With Free Credentialing Services.pptxDanny Johnsmith
Discover how free credentialing services can enhance your medical practices growth and efficiency, and why they are a smart choice for healthcare providers.
Grow Your Medical Practice With Free Credentialing Services.pdfDanny Johnsmith
Discover how free credentialing services can enhance your medical practice's growth and efficiency, and why they are a smart choice for healthcare providers.
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Module 02 Lab Assignment – General SurveyTop of FormBottom of IlonaThornburg83
Module 02 Lab Assignment – General Survey
Top of Form
Bottom of Form
Module 02 Content
1.
Top of Form
Conduct a general survey outside of school on anyone you wish. Perform this as an inspection only and document the findings in short phrases. Also, identify actual or potential risks. Submit your survey to the drop box below.
July-August 2020 • Vol. 29/No. 4 229
Diane K. Boyle, PhD, RN, FAAN, is retired Professor, Fay W. Whitney School of Nursing,
University of Wyoming, Laramie, WY.
Sarah A. Thompson, PhD, RN, FAAN, is Dean and Professor, Sinclair School of Nursing,
University of Missouri, Colombia, MO.
Funding: Research reported in this publication was supported by the Medical-Surgical Nursing
Certification Board. The content is solely the authors’ responsibility and does not necessarily
represent the official views of the Medical-Surgical Nursing Certification Board.
CMSRNs’ Continuing Competence
Methods and Perceived Value of
Certification: A Descriptive Study
Diane K. Boyle
Sarah A. Thompson
N
ursing specialty certification
builds on nursing licensure.
It acts as a mechanism for
validation or formal recognition by
documenting individual nurses’
knowledge, skills, and abilities spe-
cific to their specialty. To become
certified, nurses are required to
meet predetermined eligibility crite-
ria and achieve standards identified
by a nursing specialty, including
sufficient practical experience and
passing a certification examination
that provides external validation of
knowledge and judgment. The
intended outcome of certification
in nursing is to validate compe-
tence with the overall goal of
improving safety, quality of care,
and health outcomes for people
who use healthcare services.
(Chappell et al., 2019).
For the Certified Medical-Surgical
Registered Nurse (CMSRN®) certifi-
cation, initial eligibility criteria
are registered nursing licensure, 2
years of practice in a medical-sur-
gical setting (may include clinical,
management, or education), and
2,000 hours of medical-surgical
practice in the past 3 years.
Eligible candidates earn the cre-
dential by passing an exam
(Medical-Surgical Nursing Certifi -
cation Board [MSNCB], n.d.). To
recertify, CMSRNs must continue
to practice in a medical-surgical
setting and provide evidence of
continuing competence in the
specialty (MSNCB, 2019).
Continuing competence is “the
ongoing commitment of a regis-
tered nurse to integrate and apply
the knowledge, skills, and judg-
ment with the attitudes, values, and
beliefs required to practice safely,
effectively, and ethically in a desig-
nated role and setting” (Di Leonardi
& Biel, 2012, p. 350). The Con -
tinuing Competence Task Force
(Hospice and Palliative Creden -
tialing Center [HPCC], 2011) estab-
lished this definition to guide estab-
lishment of meaningful recertifica-
tion requirements in nursing.
MSNCB (2012), which administers
the CMSRN credential, has en -
dorsed the defini ...
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Enhancing Healthcare Efficiency The Vital Role Of Physician Credentialing Ser...MedLifeMBS
In the intricate landscape of healthcare delivery, the process of physician credentialing stands as a cornerstone for ensuring quality care and patient safety. Physician credentialing services play a pivotal role in this regard, serving as the gatekeepers to verify the qualifications, experience, and credentials of healthcare practitioners. In this article, we delve into the significance of physician credentialing services, exploring how they streamline operations, ensure compliance, and uphold the highest standards of professionalism within the healthcare industry.
LoginClinic Inc. is a leading medical billing services provider that has been in business for over 9 years. They offer a full suite of billing, EMR, transcription, and practice management services. Their medical billing services are designed to maximize reimbursements while reducing overhead costs and improving cash flow for clients. Key benefits include eliminating backlogs, reducing training time, and allowing practices to focus on patient care instead of paperwork.
Delivering care in efficient environment medicall 2011 [compatibility mode]Satishkumar Durairajan
This document discusses delivering efficient healthcare in challenging environments. It outlines issues like controlling costs, government regulations, and new technologies. It discusses what patients and hospitals want, including favorable outcomes, safety, and controlling costs. The document proposes addressing these challenges through quality improvement approaches like Lean, Six Sigma, and reducing waste. It provides examples of applying Lean Six Sigma in healthcare to improve processes and outcomes.
Discover how our state-of-the-art solutions can optimize your practice's revenue cycle! 🏥💡 Streamline billing, enhance cash flow, and ensure maximum profitability without the headaches.
Our expert team takes care of coding, collections, and more, while you focus on delivering exceptional patient care. Trust us to provide efficient #OpticalRevenueManagement services tailored to your practice's needs.
What is Credentialing in Healthcare_ A Comprehensive Guide to Understanding I...Cosentus
Credentialing is not merely a bureaucratic formality; it is the foundation upon which patient trust is built, healthcare revenue cycle management quality is assured, and regulatory compliance is maintained. Now you know all about the multifaceted components of credentialing, from verifying qualifications to assessing ethical conduct, showcasing how it serves as the guardian of patient well-being.
Similar to Newport Credentialing Solutions Capabilities Presentation (20)
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 times
Monthly 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
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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
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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
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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 and
v 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 Registered
v Neonatology
v Orthopedics
Nurse Anesthetists
v 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 will
manage every aspect of your new physician
credentialing. 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
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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
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13. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
Charting Physician Credentialing Solutions
Application Follow-Up
Newport believes that Application Follow-up
should 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
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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 credentialing
to 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
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15. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
Charting Physician Credentialing Solutions
Delegated Credentialing
Management
Our credentialing specialists mange the
complex processes related to delegated
credentialing for numerous clients. Our
services 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
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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 web
training sessions for all physicians. Educational
Topics 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
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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 many
organization 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 software
to 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
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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
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19. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
Charting Physician Credentialing Solutions
CAREreport – Facility Summary
confidential and proprietary presentation
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20. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
Charting Physician Credentialing Solutions
CAREreport – Trend Summary
confidential and proprietary presentation
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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
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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
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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
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