When a provider leaves a practice, it can feel like a wrench in the gears. Billing, more than any other department, stands to suffer if the transition isn’t managed smoothly. Letting claims slip through the cracks or failing to communicate effectively with patients can directly impact revenue. Here’s how to handle it.
Cleanup Outstanding Claims
The first order of business is tackling all outstanding claims associated with the departing provider. You don’t want these hanging around like a bad smell. Go through your A/R reports with a fine-tooth comb. Identify every claim tied to that provider, especially those 60+ days old.
Expect some pushback from payers. They may try to delay, particularly if they know a provider’s departure means less pressure from your end. Be prepared to follow up aggressively. Use direct lines or backdoor numbers if you have them. And don’t be shy about leveraging your relationships with account managers — they can sometimes expedite a resolution if they know the urgency.
Manage Recredentialing Processes
When a provider leaves, their replacement needs to be credentialed as soon as possible. Recredentialing can be a bureaucratic headache, but don't let it stall your billing processes.
Start the recredentialing process for the new provider immediately. The application forms are often complex, and each payer has its own peculiarities. For instance, some payers may have online portals (with various quirks) that allow submissions, while others might still require paper copies.
Remember that credentialing can take anywhere from 30 to 120 days, depending on the payer. Keep tabs on each application’s progress — set calendar reminders to follow up. Delays here can mean unpaid claims down the road.
Update Your Billing System
Ensure that your billing system is promptly updated to reflect provider changes. This includes updating fee schedules and payer contracts tied to the departing provider. Double-check that the replacement provider’s information is accurately entered once they’re credentialed.
Billing systems can sometimes default to old data — a small error here can lead to rejections from payers. Quality control is crucial. Run test claims to make sure everything's firing on all cylinders.
Communicate with Patients
Patient trust is at stake when a provider leaves. That trust can be eroded if billing issues arise due to the transition. Effective communication is key.
Notify patients well in advance of the provider’s departure (when possible), and inform them about any potential impacts on their billing. This isn’t necessarily a huge task — a simple note or email clarifying what patients should expect can prevent confusion and calls to your billing office.
Be upfront about potential delays or hiccups. Patients understand that transitions happen. What frustrates them is being left in the dark. Transparency can save you a lot of time and trouble.
Address Denials and Rejections
Provider departures can lead to an uptick in claim denials or rejections. Maybe the billing system wasn't updated quickly enough, or transitional hiccups occurred with recredentialing. Whatever the case, these need swift attention.
Track any uptick in specific denial codes. For example, if you're suddenly seeing many "N95" (missing/incomplete/invalid provider identifier) denials, that’s a red flag that your provider data hasn't been updated correctly across all systems.
Designate a team member to focus on these transitional denials. End-of-day reports can pinpoint which claims need urgent re-submission or correction.
Maintain Relationships with Payers
Don't underestimate the value of keeping lines of communication open with payers during this time. Inform them about the provider change and what it means for your claims. This proactivity can sometimes lead to leniency in claim processing or extensions on reconsiderations.
Again, lean on those account managers. They can be a lifeline during transitions, helping fast-track claims or smooth over discrepancies.
Review and Adjust Workflows
Provider departures naturally lead to workflow adjustments. Review your current systems to identify potential bottlenecks that may have been exacerbated by the transition.
For instance, if a departing provider had a unique billing code usage, ensure that these codes are still being used correctly, or alter them to fit new practice guidelines. This prevents confusion and ensures billing continuity.
Takeaway: Anticipate, Don’t React
Provider departures are inevitable, but the chaos they bring is not. Anticipation is your best ally. By prioritizing outstanding claims, managing recredentialing efficiently, updating systems, communicating with patients, and leveraging payer relationships, a practice can navigate these transitions without hemorrhaging revenue. Remember, your billing team is the linchpin in maintaining financial health during such transitions. Ensure they have the tools and support they need to excel.
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