6 Common Mistakes in Provider Enrollment

Why is it so important to enroll locum tenens physicians correctly?

• Accurate enrollment opens the door to accurate provider billing, preventing revenue loss.
• It ensures compliance with Medicare and Medicaid, avoiding fines and other legal repercussions.
• It reduces the backlog of claim denials and other hang-ups in the billing process to come, which are already a burden on industry billing professionals.

As someone with extensive, hands-on experience in the billing and enrollment world (for locum tenens providers and full-time), I've seen firsthand how small oversights and assumptions can impact organizations, resulting in the headaches of extra time and extra cost. Here are some of the top mistakes we often encounter and how our consulting services can help enrollment professionals streamline their processes and avoid these costly errors.

1. Lack of Follow-ups 

Effective follow-up is pivotal in order to ensure enrollment is completed in a timely manner. Many organizations overlook this step, but this is the single most important part of the enrollment procedure. Regular follow-ups ensure the applications keep moving through the processing phase and can sometimes result in a quicker approval process.  can be lost in the queue, which can result in the processing coming to a full stop or a denial. Proper follow-up helps avoid those denials and ensures timely revisions.

2. Misunderstanding Backbilling Procedures

The fast-paced nature of healthcare means that enrollment approval may not coincide with the provider’s start date. Backbilling—which enables providers to see patients while the enrollment is still in process—is a vital practice in some scenarios. Having a thorough understanding of each payor’s requirements or restrictions on backbilling, including how far back they allow effective date retro requests, can help avoid or resolve tough situations for your organization. 

3. Inadequate Tracking

Managing the enrollment processes for multiple providers simultaneously can be overwhelming. Implementing a reliable system to track every application and its enrollment status can alleviate confusion.

Furthermore, implementing check-ins with stakeholders involved in the enrollment and billing process can ensure everyone is kept in the loop. Effective communication can often be the deciding factor in securing approvals and preventing denials down the line—which brings us to our next point.

4. Poor Communication between the Necessary Parties 

Communication can be, at times, the most challenging aspect of the enrollment process. Ensuring that all parties are involved and kept in the loop is crucial, especially when you are working with a locums agency. Understanding who to contact for the various issues that sometimes arise can be daunting. 

The locums agency you work with should be taking charge of enrollment communications proactively, working collaboratively with your organization to ease your struggles and find the best resolution. If they are operating in partnership with you, that is a sign that you have tapped the right organization to work with. 

5. Lack of Awareness Around Locums Provider Enrollment

The biggest enrollment misconception is the assumption that you cannot complete enrollment for a locum tenens provider. This relates to the Q6 modifier, which was traditionally thought of as the only way to bill for locums.   

The Q6 modifier allows you to have a locum tenens physician cover for a physician at your practice who is going on a temporary period of leave. This modifier can only be used for 60 days or less and permits you to bypass the enrollment process entirely.

However, if you are bringing on an advanced practice provider (APP) or you do not have a physician-to-physician coverage, it is necessary to fully enroll that locums to be able to bill at all. 

6. Not Updating the Provider’s CAQH Profile 

A CAQH profile plays an important part in enrolling a provider with private plans. Private insurers utilize a CAQH profile to enroll a provider, which requires a provider to attest to a profile every 120 days to remain compliant.  If a profile expires or becomes outdated, private plans may drop a provider from their network.