The Scenario
A medium-sized physician group was spending $45k+ for one FTE (full-time equivalent) to maintain 12 provider’s credentialing files and insurance companies ongoing credentialing requirements.

The Method
A qualified consultant was brought in to cut costs and increase revenue through:

proper implementation
maintenance
technology
Calls with the administrator and the outsource company collected all of their 12 provider’s documentation via the web and the entire credentialing department started to run systematically. Presently, the administrator gets reminder notices about license renewals and pertinent updates and information on each provider and responds accordingly. She now devotes 2-5 hours a month total to the total task.

The Results
This outsourcing strategy saved this particular practice one FTE, $45K (plus benefits). Additionally, the consulting firm discovered some pre-existing errors during the transition. It appears that there was a total of 3 issues that went unnoticed during the initial enrollment regarding the provider’s specialty. Thus reimbursement was 17% lower annually during their total enrollment with their payor for 7 years previously. This translated into over $425K in lost revenue for that practice during the time period that the initial enrollment mistakes went undetected.

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