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Case Studies

Explore how partnering with STAT MedCare has helped multiple healthcare practices in the most challenging credentialing, payor enrollment, and provider enrollment processes. See the difference that STAT MedCare’s expertise can make.

Case Studies

STAT’s . Impact on Its Clients

How STAT saved a Client more than $45K per Year

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:

maintenance

proper implementation

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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How STAT helped a Client get Enrolled as a Multi-Specialty Specialist

The Scenario

A board certified anesthesiologist and addiction medicine specialist wanted to be enrolled with BCBS and United Healthcare. However, the American Board of Addiction Medicine is not a member of the American Board of Medical Specialties (ABMS). The process to bring addiction medicine into the ABMS as a multi-specialty subspecialty, through sponsorship by the American Board of Preventive Medicine, began in February 2015. However, most plans do not recognize multi-specialty subspecialty as a board certified specialty. Therefore, the plans wanted the client to be credentialed in their behavior health program. The client, and the specialty itself, insisted it was a medical specialty.

The Method

The following was conducted:

Phone calls to the two insurance companies;

Research on the specialty and the board; and

Research on BCBS and United Healthcare rules concerning multi-specialty providers.

The Results

The client’s contracting with STAT resulted in BCBS approving the provider as a multi-specialty specialist in medicine. STAT was able to leverage BCBS’s approval to obtain United Healthcare approval.

The client is now receiving reimbursement from two primary payors in his market.

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How STAT Increased a Client’s Revenue by 50%

The Scenario

A behavioral health practice of 100+ providers (MDs, PhDs, NPs, LSWs) with 70 different programs and multiple locations was losing revenue because the majority of its facilities were billing through the county instead of having direct enrollment/contracting with governmental and commercial payors. The client was interested in generating additional revenue by getting some of its facilities and providers enrolled with several payors. The practice attempted to do enrollment in-house but did not have the resources or expertise to successfully get enrolled.

The Method

STAT MedCare had an introductory conference call to gather all the necessary documents on the practice and its providers. In addition, provider profiles were built into our credentialing system, STATCred.

STAT MedCare initiated the enrollment with several government and commercial payors.

Weekly conference calls were scheduled with the client to discuss progress.

The Results

The client was enrolled with all targeted government and commercial payors. The outsourcing of payor enrollment to STAT resulted in the client obtaining a 50% increase in gross revenue.

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How a Client loses $0 in Revenue

The Scenario

STAT completed all initial appointments for this 90+ provider surgical center. However, this long-term client did not have a system to monitor and track its providers’ appointment dates and expirables.

The Method

As part of this engagement, STAT conducts the following:

At the reappointment dates of 90/60/30 days, STATCred sends an automated notification via email to the Lead Medical Staff Coordinator;

STAT completes all reappointments and updates the system with new reappointment date(s);

STATCred also monitors the providers’ expirables data at 90/60/30 days and sends an automated notification to the Lead Medical Staff Coordinator;

As items are renewed, expirations dates are updated and documents are uploaded into STATCred for continued monitoring; and

A weekly status report is provided to the client with all completed and in-process tasks.

The Results

There have been $0 in lost revenue due to credentialing (i.e., due to having an automated monitoring and tracking system in place for all reappointment dates and expirables).

Case Study – Copy – Copy

Case Studies

Case Studies

STAT’s . Impact on Its Clients

How STAT saved a Client more than $45K per Year

The Scenario

The Method

The Results

Take the Next Step

How STAT helped a Client get Enrolled as a Multi-Specialty Specialist

The Scenario

The Method

The Results

Take the Next Step

How STAT Increased a Client’s Revenue by 50%

The Scenario

The Method

The Results

Take the Next Step

How a Client loses $0 in Revenue

The Scenario

The Method

The Results

Take the Next Step

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