Newport Credentialing Solutions Capabilities Presentation

1. Re-­‐Defining
the
Physician
Creden4aling
Life
Cycle
Capabili(es
Presenta(on
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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
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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
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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
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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
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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
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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
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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
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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
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21. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
CAREreport – Department Summary
confidential and proprietary presentation
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22. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
Charting Physician Credentialing Solutions
CAREreport - Provider Summary
confidential and proprietary presentation
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23. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
Charting Physician Credentialing Solutions
CAREreport - Provider Summary - Aging
confidential and proprietary presentation
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24. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
Charting Physician Credentialing Solutions
CARElist - Dashboard
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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
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26. Charting Physician Credentialing Solutions
Re-Defining the Physician Credentialing Life Cycle
Charting Physician Credentialing Solutions
CARElist - Worklist
confidential and proprietary presentation
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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
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