Debunking Provider Enrollment Myths

We sat down with provider enrollment experts to talk about the critical process of provider enrollment and why it is vital to healthcare operations. Matt Littlejohn (CVO Manager – Provider Enrollment) and Alan Ashby (Vice President, Primary Care) share what they are seeing in the enrollment world from small healthcare facilities to major health networks – and why optimizing provider enrollment is so essential to avoid costly delays.

But a few myths prevail in provider enrollment that are holding healthcare organizations back and impacting bottom lines across the care continuum.

Myth 1: Locum tenens providers are short-term solutions that you cannot be reimbursed for.

• Alan Ashby:
  The locum tenens industry has evolved so much over the years. When I started almost 16 years ago, locums were truly a band-aid for medical workforces. In our clients’ eyes, it was considered an unavoidable solution but not a desirable one, and there was a stigma that clinicians who worked locums were seen as less skilled or qualified. Now, however, healthcare organizations budget for locums and recognize their value. Clinicians leaving residency are choosing locums as a career path that better fits their lifestyle. What was once a simple replacement is now a widely accepted workforce solution that will increase as the demand for healthcare clinicians continues to outpace supply.
  
  
• Matt Littlejohn:
  The biggest misconception in provider enrollment that healthcare organizations need to address is that the Q6 modifier does not allow you to bill for every locums situation. For example, with the growth of the APP (Advanced Practice Provider) market, the days of using the Q6 modifier as a solve-all is dwindling. Recognizing that the Q6 is being phased out will allow organizations to think critically about how they plan to bill for the locum tenens clinicians they are onboarding.

Myth 2: Delays are just part of the enrollment process.

• Alan Ashby:
  Delays in provider enrollment impact healthcare organizations both operationally and financially. Credentialing and Privileging deadlines are especially important—but I believe speed and efficiency in provider enrollment is even more critical early on. A slow enrollment application submission or a delayed response to a payor when additional information is needed to complete enrollment can mean tens of thousands of dollars.
  
  
• Matt Littlejohn:
  More often than not, enrollment falls by the wayside due to multiple items on the onboarding checklist and many stakeholders involved in the conversation. Combined with uncertainty of how to bill for locum tenens in general, this can be a perfect recipe to cause disarray.

Myth 3: Enrollment is not big enough to affect the bottom line.

• Alan Ashby:
  Timely and accurate provider enrollment has a significant impact on healthcare facilities’ bottom lines. For every day an organization fails to bill for services, it can cost that organization over $10,000 on average. For a week, that is over $70,000, and for a month, that is a staggering $300,000 or more.
  
  
• Matt Littlejohn:
  The most crucial information that healthcare organizations should know about provider enrollment in 2024 is that, with the Q6 being phased out increasingly, this is bringing full enrollment to the forefront of the conversation.

Myth 4: Your organization is meant to fend for themselves in enrolling their locums.

• Alan Ashby:
  What we are seeing in the market are healthcare organizations that know how to bill for permanent employees, but there is confusion around how to bill for locum tenens clinicians. In other cases, the organizations understand and know how to bill for locums, but their internal staff is stretched then, and lack of bandwidth is a factor.
  
  
• Matt Littlejohn:
  An agency can support enrollment professionals in achieving their objectives by becoming a partner in the process. Not only should an agency partner be able to guide and advise throughout the enrollment process, but they should be willing to be in the trenches with an organization working on the enrollment piece. This includes guidance through the processes and portals, but also being hands-on in that process.

Myth 5: Provider enrollment does not have to be proactive.

• Alan Ashby:
  While Medicare and other payors do allow healthcare organizations to back bill for services, most of the time the organization can only back bill 30-120 days (about 4 months) depending on the state and the payor. Once that window closes, it closes for good, and they cannot recoup the revenue.
  
  
• Matt Littlejohn:
  A consultative partner can assist organizations in achieving accurate and efficient enrollment from the outset by taking a proactive approach instead of being reactive. This reactive approach created situations where organizations would be trying to back-bill to collect whatever small amount they could, or in some cases not even billing for the locums clinicians at all. By taking a proactive approach, the locum tenens agency can turn into a partner for an organization, working on the front lines to ensure the locums clinicians can be enrolled and billed for.

Rethinking provider enrollment is essential for healthcare organizations to thrive as the roles of providers evolve and demand for flexibility increases. Contact our team today to learn more about streamlining your provider enrollment processes and avoiding financial pitfalls.