Ask Five Questions to Determine if Provider Enrollment is Impacting Your Cash Flow

Debra K. Carter, MS, CPMSM, CPCS
Manager of Provider Enrollment Services
Synernet, Inc.

Portland, ME

Asking five simple questions within your healthcare organization can improve your bottom line while streamlining processes.  Provider Enrollment is a fundamental aspect of any healthcare providers reimbursement and revenue cycle. At Synernet we have a process of client engagement that includes a 360 degree look at the facilities billing process to align provider enrollment.

Question 1: What is your monthly claims on hold dollar amount due to enrollment?

Develop and require a monthly tracking and reporting of claims on hold.

  • Communicate on hold reports across department lines
  • Work toward a goal of $0
  • Track trends

Question 2: What claims are being denied due to provider enrollment?

  • Identify “root causes” of enrollment denials
  • $0 should be the goal

Question 3: How much ‘written off” claims due to incomplete enrollment?

  • Set a goal of $0
  • Automate the form submission and tracking process
  • Import provider data to improve accuracy

Question 4: What is the dollar amount of claims unable to submit due to non-par enrollment?

  • Review results monthly to identify trends
  • Aggressively reduce provider Non-Par denials
  • Eliminate Non-Par write-offs

Question 5: What is the average number of days unable to bill due to non-enrollment for newly employed practitioners already providing services to patients?

  • Enrollment starts with HR and recruitment
  • Communication is vital between HR, Billing, Medical Staff Office and practice locations.
  • What time factors are in place for the enrollment process?
    • Allowing time for the provider to be enrolled
    • Aggressively reduce the average days unable to bill

To learn more about the Provider Enrollment process, best practices and Synernet’s role in helping healthcare organizations achieve their goals, visit www.synernet.net or contact Deb Carter, MS, CPMSM, CPCS at dcarter@synernet.net

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