Allyson Schiff, VP of Enrollment Services, TractManager
Provider onboarding, credentialing and enrollment are critical business processes that directly impact revenue cycle management. Yet, far too often they are overlooked until declining revenue and rising compliance exposure reach a financial tipping point. For hospitals, the tipping point can reach upwards of $300,000 for specialists and $100,000 for primary care providers in revenue that is either not realized or written off as “bad debt.” There are several challenges health systems, hospitals, and physician practices share that contribute to this problem: 1. Systems are siloed and supported by legacy technologies that do not communicate with each other; 2. Lacking centralized data sources, multiple departments from contracting to human resources, to medical staff and managed care services are forced to rely on manual and often redundant processes; 3. The lack of interoperability in provider credentialing and enrollment is endemic, and leads to frustrated physicians, inadequate network coverage, compromised member access, and revenue leakage. A modern, cost-effective, single-platform solution is needed to maximize credentialing’s contribution to effective revenue cycle management.
The leading provider of Strategic Sourcing applications and Contract Management software for healthcare, TractManager improves the health of the revenue cycle through an integrated technology platform, and professional services that optimize each credentialing component in the provider lifecycle.
TractManager’s acquisition of Newport Credentialing Solutions, the leader in cloud-based credentialing and provider enrollment software and services, expands its “gold standard,” contract lifecycle management portfolio, and brings together two best-in-class solutions that positively impact the healthcare revenue cycle. “Newport was founded on the belief that the revenue cycle begins when a provider initiates enrollment with a payer,” states Allyson Schiff, VP of Enrollment Services at TractManager. “We reduce the turnaround times for paneling providers with complete, accurate technology-enabled processes, and this is why we’re able to significantly impact the front-end of revenue cycle management by 50 percent.” This sounds simple enough, however, complexities attributable to differences in state, federal, and payer-specific regulations quickly emerge. Allyson explains: “Many organizations consider enrollment complete when they identify a provider in a directory, but without evaluating the data that supports the provider’s participation and eligibility for participation, it’s a dangerous assumption to make. It’s only when enrollment is managed holistically, that good results happen; we helped one large, multi-specialty practice achieve an additional $1M in revenue in the first year of our partnership by enrolling a specialty type that had been previously excluded.”
Compliant, effective credentialing begins and ends with data insights that uncover and correct discrepancies to ensure providers are properly paid for the care they have provided.
We reduce the turnaround times for
paneling providers with complete,
processes, and this is why we’re able
to significantly impact the front-end
of revenue cycle management by 50
Allyson continues, “TractManager conducts a comprehensive data analysis with payers to ensure that a provider is accurately enrolled for each location, linked to the appropriate contract and billing Tax ID, and is within the contracted scope of specialty. This important step in our proprietary process allowed us to resolve over $30M in outstanding accounts receivable and potential bad debt for a large, multi-hospital health system. We centralized network data, linked provider and location-specific data to outstanding gross charges, and engaged the payers in a systematic reconciliation effort for each of our client’s enrollment opportunities .”
Anna Arutyunyan, VP of Credentialing Services, TractManager
TractManager’s multifaceted, revenue cycle management approach includes leveraging technology to realize revenue quickly. “We specialize in intelligently designed, dynamic technology – a stark contrast to legacy systems that do little more than house data. With hundreds of primary source integrations that include CMS Sunshine Data, field-level business rules and triggers, and alert-driven workflows, we partner with healthcare organizations to operationalize their compliance, contracting, credentialing and enrollment programs with a single integrated platform,” explained Anna Arutyunyan, VP of CVO Services at TractManager. “The number of State and Federal regulations concerning provider data is at an all-time high – from new reporting standards to CMS billing procedures. And the penalties incurred for incomplete or incorrect data can quickly add up to millions of dollars in constrained revenue,” continues Anna. “Every day we answer the market need for a single solution to manage network growth, contracting, credentialing, and payer enrollment compliantly.”
Anna added, “We have a proven record of success because we approach revenue cycle management from a holistic, technology-enabled perspective. Our clients depend on our software to identify potential compliance risks, reduce contracting and credentialing approval times, and prevent denials with our extensible payer enrollment functionality. For example, a preeminent West Coast academic health center reduced provider contracting times by 70 percent, which accelerated the time to revenue when onboarding new providers.”
TractManager’s credentialing teams are excited to be a part of their clients’ revenue realization at every level. Allyson noted, “We’ve leveraged our industry expertise with a solution that directly impacts the financial health of organizations, the quality of care, and the physician experience.” As Anna concluded, “We’re excited to help organizations strengthen their revenue cycle management with technology infrastructure and services that drive speed and efficiencies.”