Newport Credentialing Solutions Capabilities Presentation

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Re-‐Defining the Physician Creden4aling Life Cycle Capabili(es Presenta(on

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Charting Physician Credentialing Solutions

confidential and proprietary presentation

Mission and Values

Re-Defining the Physician Credentialing Life Cycle

Newport Credentialing Solutions is to be the nation’s premier provider of cloud based software and comprehensive services dedicated to the

physician credentialing life cycle. Our values are:

✤  Listen to our client’s challenges and needs ✤  Commitment to our client’s mission ✤  Develop innovative, solution driven software ✤  Relentless pursuit of Excellence ✤  Intense focus on Exceeding our client’s expectations ✤  Teamwork ✤  Accountability

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The Problem



✤  The Affordable Care Act (ACA) and the evolution of Accountable Care Organizations (ACOs) has forced hospitals to align themselves with physician groups at unprecedented rates

✤  Reimbursement rates are dropping

✤  Physicians are forced to deal with administrative tasks rather than practice medicine

✤  Administrative tasks “fall through the cracks” which negatively impacts revenue

A 2003 AMA study concluded that healthcare organizations spend up to $1B per year on administrative costs related to credentialing management


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The Result of The Problem




✤  Credentialing has historically never been viewed as a critical component of the revenue cycle

✤  Credentialing software programs, while valuable for hospital privileging, have completely ignored the provider enrollment side of credentialing. Failures include:

✤  Not understanding that revenue is tied to every enrollment

✤  Not understanding that processing times effect revenue

✤  Enrollment and Payer Performance benchmarks do not exist

✤  Real world, process driven workflow software does not exist

✤  Incredibly difficult to use and highly in-efficient

✤  The lack of focus on credentialing directly effects higher AR days, increased denials, non-par payments, customer service issues, and frustrated providers.

If you are not enrolled correctly, you will not be paid correctly


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Why is Credentialing Management Costly and Inefficient?

v  High Cost Overhead, Management and Staff Resources: (average skilled resource = $35-45K/year + Fringe)

v  Lack of Standardization: Despite efforts by CAQH and other administrative bodies, insurance companies continue to request physician credentialing information in non-standard formats

v  Processing Difficulties:

✤  Difficult to track down provider documentation and signatures

✤  Time intensive processing (numerous payers and lengthy applications (40-50 pages long)

✤  Complex:

v  Difficult to correctly link PINs, TINs, Place of Service, and Pay to Addresses to specific groups, organizational contracts or fee schedules

Studies have shown that the average provider completes 15 to 20 applications per year and spends 1 to 2 hours per application completing these forms. The time alone

to credential one physician could be up to 40 hours. confidential and proprietary presentation

Charting Physician Credentialing Solutions Re-Defining the Physician Credentialing Life Cycle

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Credentialing Economics (Initial Physician Credentialing)

✤  10 Doctors bill $10M annually

✤  5 additional doctors join an existing medical practice bringing the total number of doctors to 15 and billings to $15M

✤  $10M in billings results in $4M in annual collections. $15M in billings results in $6M in annual collections

✤  5 additional doctors will bring in an additional $2M in annual collections or $5,479 per day to the organization’s bottom line

Typical Credentialing times are 180 days.

By decreasing your Days In Enrollment by 90 days, your practice could realize incremental revenue of $493,110. $-

$100,000

$200,000

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Monthly Collections with 5 Additional Doctors in March 3 Month Credentialing vs. 6 Month Credentialing

3 Month Credentialing 6 Month Credentialing



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For every day your physicians are not re-credentialed, your practice may lose $5,479 in billable charges or $2,191 of collections.

Credentialing Economics (Expirables Management)

✤  10 Doctors bill $10M annually over 10 payers

✤  Doctors collect $4M annually or $10,958 per day

✤  Doctors credentialing expires for two payers resulting in $2M of annual lost charges or $5,479 per day

✤  The typical re-credentialing process takes 180 days

✤  180 days of re-credentialing at $5,479 per day results in $986,220 in lost billable charges or $394,488 in lost collections ($2,191 per day)

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Monthly Collections after Expiration in March 3 Month Re-Credentialing vs. 6 Month Re-Credentialing

Continuous Re-Credentialing 6 Month Re-Credentialing



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Comprehensive Solutions



Newport Credentialing Solutions is the nation’s premier provider of cloud based software and comprehensive services dedicated to the physician credentialing life cycle

v  Comprehensive Physician Credentialing Services

v  Complete Initial Enrollment

v  Document Management

v  Application Processing and Follow-up

v  Expirables Management and Re-Credentialing Services

v  Delegated Credentialing Management Services

v  Cloud Based Workflow and Analytics Software - CARE

v  Comprehensive

v  Accounts

v  Receivable

v  Enrollment


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Comprehensive Credentialing and Expirables Management – ROI

Newport’s comprehensive credentialing and expirables management services increases efficiencies through centralization, reduces operating costs, and generates incremental revenue.

v  Increased Efficiencies Through Centralization v  Centralized Enterprise Management v  Faster Processing and Turn Around leading to incremental revenue v  Enterprise Reporting to drive accountability

v  Reduced Operating Costs v  Re-allocation of staff to higher ROI functions (e.g., Front End Activities, AR Collections, etc.) v  Reduction of staff leading to increased bottom line revenue

v  Incremental Revenue v  Quicker processing and turn around reduces payer processing time which directly translates to

incremental revenue v  Providers are able to see and bill for patients sooner which directly translates to additional patient

revenue v  Reduce provider salary outlay without return



Clients often see a 10 to 1 return on their investment for net new provider enrollments


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Experience



v  Radiology v  Pathology v  Dermatology v  Internal Medicine v  Gastroenterology v  OB/GYN v  Pediatrics v  Surgery v  Cardiology v  Neonatology v  Allergy and

Immunology v  Infectious Disease v  Psychiatry v  Psychology v  Dentistry v  Physician Assistant v  Nurse Practitioner

v  Social Workers v  Certified Nurse Mid-

Wives v  Emergency Medicine v  Hospitalists v  Family Medicine v  Hematology v  Oncology v  Neurology v  Orthopedics v  Sleep Medicine v  Sports Medicine v  Urology v  Endocrinology v  Geriatric Medicine v  Nephrology v  Nuclear Medicine v  Otolaryngology

v  Nutrition v  Speech Pathology v  Audiology v  Physical Therapy v  Physical Medicine and

Rehab v  Pain Management v  Anesthesiology v  Certified Registered

Nurse Anesthetists (CRNAs)

v  Chiropractors v  Critical Care Medicine v  Optometry v  Ophthalmology v  Occupational Therapy


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Comprehensive Credentialing Services

Newport’s Comprehensive Credentialing Services will manage every aspect of your new physician credentialing. Services include:

✤  Complete and Pro-Active management of all new physician credentialing

✤  On-site collection of primary source documentation

✤  Rapid Data Entry

✤  Quality Assurance to ensure accuracy

✤  Packaging of all paper applications

✤  Work with the client to obtain physician signatures

✤  Expedited mailing to payers for processing

✤  Management of delegated credentialing rosters



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Document Management


Demographic and General Information

Education

Current and/or Prior Affiliations

Practice Information

References

Licensure

Board Certification

Insurance

Attestation

Attachments

Training

Work History

Liability Coverage

All primary source documentation is centralized and electronically stored on our advanced credentialing workflow software. Clients may have access to their primary source documentation 24/7.



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Newport believes that Application Follow-up should be handled just like AR Follow-up: ✤  Rigorous ✤  Systematic ✤  Standardized Newport checks the following: ✤  The application was received ✤  The payer is actively processing the

application ✤  That all processing data requirements have

been fulfilled ✤  Identify estimated payer completion date

Application Follow-Up



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Re-Enrollment and Expirables Management

Newport will manage your physician’s credentialing to ensure that there is no lapse in credentials. Expirables management includes: ✤  Pro-actively monitoring document expiration

(e.g., licenses, DEA registration, board certification and professional liability insurance) using our easy to use expirables management reminder system

✤  Manage all re-credentialing activities ✤  Process all CAQH re-attestations (every 120

days) ✤  Pro-active dialogue between Newport and

client’s billing department/vendor



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Delegated Credentialing Management

Our credentialing specialists mange the complex processes related to delegated credentialing for numerous clients. Our services include: ✤  Managing various submission formats for all

delegated payers ✤  Managing weekly/monthly delegated

credentialing updates with all payers ✤  Proprietary workflow software designed to

easily update and monitor delegated spreadsheet formats



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Newport understands that: EDUCATION = ADHERENCE As such, Newport provides both on-site and web training sessions for all physicians. Educational Topics include: ✤  What is credentialing and why is it important? ✤  How often does it occur? ✤  How will this effect me and how much time

will this take away from my patients? ✤  What will I need to do to be compliant?

Education


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Cloud Based Workflow and Analytics Software

Newport understands that credentialing is often viewed as a “black hole” in many organization’s revenue cycles. Existing in the middle of Front End and Back End operations,

credentialing is often overlooked as a critical component of the revenue cycle.

Credentialing Data = Revenue Newport has developed proprietary, cloud based workflow and decision support software to help drive critical financial, operational, and process decisions. The following slides depict

some images of the patent pending software that we provide our clients.



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Blocked Out, Blocked Out , Blocked Out, Blocked Out

CAREreport – Institutional Summary


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CAREreport – Facility Summary


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CAREreport – Trend Summary


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CAREreport – Department Summary


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CAREreport - Provider Summary


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CAREreport - Provider Summary - Aging



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CARElist - Dashboard



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CARElist - Worklist



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CARElist - Worklist



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Summary of Services v  Comprehensive Credentialing Services with

Minimum Interruption to Organizational Management and Staff

v  Expirables Management Services v  Re-Credentialing Services v  Delegated Credentialing Management

Services v  Cloud Based Workflow and Analytics

Software - CARE v  Comprehensive v  Accounts v  Receivable v  Enrollment



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✤  Address: 241 Rockaway Ave, Suite 102 Valley Stream, NY 11580 ✤  Phone: 516.593.1380 ✤  Fax: 516.566.2375 ✤  Email: [email protected] ✤  www.newportcredentialing.com


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Newport Credentialing Solutions Capabilities Presentation