Develop A Sustainable Credentialing Practice Using the Team Method

— By Matt Zabolotny

Credentialing and enrolling the providers within your company is a team effort. In order to efficiently verify skills, negotiate payer contracts, enroll practitioners and monitor denials, it is important to ensure these tasks are assigned to appropriate staff or departments. This paper will outline an effective approach to managing and tracking the time-consuming tasks required for credentialing and enrollment.

Before outlining the roles assigned to each of the four areas, it is important to understand the difference between credentialing and practitioner enrollment:

Credentialing involves verifying the skills, training and education of practitioners at the time of hiring. Verification is done by contacting the primary source where the provider was licensed, trained, and educated. Insurance companies use the same information and sources to allow providers to participate in their network.

Practitioner Enrollment (also known as insurance credentialing) is a piece of credentialing but not the entire process. Enrollment is an active operation of submitting applications, monitoring approvals, and communicating with payers to ensure a smooth and timely process.

Every company has functional areas that assist with credentialing and enrollment. Establishing the duties of the following staff members or departments and aligning their roles will ensure you have an efficient and effective credentialing model.

Human Resources

Verifying the qualifications of new staff members at the time of hire will give you a jump start on the credentialing process. Gather documents at the time a candidate accepts the job offer and communicate with other departments about new hires or terminations.

Payer Contracting

Executive level involvement is vital for maintaining a clear understanding of your obligations as a provider and developing good relationships with payers. After conducting a “deep dive” of your contracts, you will know if payer requirements align with the services of your company and how a contract is impacting your revenue cycle.
All Four Departments are Equal and Must work in Harmony!

Provider Enrollment

The department or team member assigned to provider enrollment must learn the requirements of each payer in order to successfully enroll your practitioners. Insurance payers are unique in their application requirements, method of submission, and turnaround time for approval. Developing a system of organizing your documentation and monitoring each application status is critical for an efficient and smooth process.

Revenue Cycle

Inaccurate credentialing and correctly enrolling providers can directly impact the financial health of your company. Insurance denials related to credentialing or contracting issues can lead to unnecessary claim rejections.

When these four teams work in tandem, you will see the benefits of developing and maintaining an efficient credentialing model. In order to successfully implement the Team Model, provide the necessary support and cultivate an environment of communication so no stone is left unturned. With consistency and commitment, you will gain a sustainable method for credentialing and enrollment.

5 Questions to Ask When Choosing an RCM Partner

— By Matt Zabolotny
Blog Post

Managing your company’s revenue cycle is a time-consuming task and directly contributes to the financial health of your business. Whether you are experiencing an increase in denied claims or a high rate of staff turnover, your bottom line is feeling the strain.

Before you connect with a consulting service, it is important to prepare yourself, so the process is efficient, and you find the right partner to meet your needs.

Conduct an Internal Audit

It is important to take your time and review the most critical needs in your business. Assess each function of your company and identify where workflow, revenue, or processes lag. Ideally, you will want to consider the areas of your revenue cycle impacting your bottom line. Even one area, such as billing, denied claims management, or patient collections, can decrease cash flow if not maintained properly.

Choosing the Right Revenue Cycle Management Partner

When researching firms, asking the right questions will help you determine if a future partner will meet the specific needs of your company. The faster you can make an informed decision, the sooner your processes and cash flow will improve. Consider the following topics before meeting with a consultant:

1. How Soon Will Claims Be Reprocessed?

If you struggle with unpaid or denied insurance claims, you will need a timeline for how soon your consulting firm will begin reprocessing claims. It is important to know if any factors, such as staff training, will impact the initial turnaround for reprocessing.

2. What is Their Experience?

Ideally, the consulting firm you choose will have employees with first-hand experience in revenue cycle management. In order to best fit your needs, an optimal partner will have successfully worked through similar billing problems with other clients.

3. What Services Do They Provide?

A seasoned and knowledgeable consulting team will be familiar with all aspects of RCM, even if they will not oversee all areas of your company’s revenue cycle. A firm may exclusively offer claims management or patient collections, but not coding services. Find a company that offers exactly what you need to help your business.

4. How Will the Partnership Increase Your Revenue?

Ultimately, you are considering a consulting partner because your bottom line is suffering, and you wish to spend more time focusing on patient care. A reputable and experienced third-party management team will have case studies and a proven track records of helping other providers like you prioritize their business needs and increase revenue.

5. Will They Communicate Regularly?

It is important to know all aspects of your business, even if part of your RCM is managed by a third-party. A consultant should provide regular reports and communications in order to exhibit how their work has improved the financial health of your facility.

Outsourcing your RCM is not an easy decision, but the best company will address any concerns quickly and confidently. ZMark Health is ready to answer your questions – and more – to help your business grow and give you peace of mind.

Outsourcing Revenue Cycle Management

— By Matt Zabolotny
Blog Post

Revenue Cycle Management (RCM) drives your business. Once you schedule a consumer, there are necessary steps involved to ensure you receive final payment for services provided. However, like most providers, you are experiencing a financial strain due to any or all the following:

  • Recruiting, training, and maintaining staff to help support the work involved with an effective RCM.
  • An increased volume of consumers, providers, and participants.
  • Growing consumer debt collections and a decrease in payer reimbursements.

If this sounds familiar, now is a perfect time to research outsourcing all or part of your RCM process. Managing consumer care at your organization is a top priority, but without healthy finances and cash flow you will put the success of your business at risk. If you are struggling to balance consumer care with inefficiencies in your RCM, consider the following reasons for outsourcing your billing and collections:

Better Cash Flow – Meet the demands of your growing business with help from an experienced team with an established RCM process. We will help you solve your billing challenges, opening the door for increased revenue and timely payments from insurance companies.

Reduce Expenses – Operating an in-house billing department requires a serious investment on your part but comes with the added stress of employee turnover, training, and retention. Outsourcing to a third-party company with a successful record will create optimized workflow and reduce your expenses over time.

Compliance Management – Evolving industry standards means staying up to date on billing rules, compliance regulations, and insurer submission guidelines. A consulting company stays on top of compliance rules and payer guidelines to ensure a streamlined billing process.

Prioritize Client Services – With the day-to-day tasks of billing management, claim submission, and payer appeals handed over to a trusted and experienced team, it creates more time for you to focus on consumer care.

A Deeper Analysis – Managing the daily tasks of a business office and providing client care means little extra time for analyzing your current RCM process. An outside billing company has the resources and capabilities to extract data, identify problems, and provide solutions within your RCM system. Doing so allows you to implement sound billing practices and solidify the financial health of your company.

Gain an Edge with ZMark Health

We are here to provide guidance on or manage your Revenue Cycle Management process. With our services, you will increase profitability and improve efficiency. Contact us today to learn more about the support we can provide.

Fellowship House Partners with ZMark Health

Press Release

Fellowship House in Miami, FL has signed an agreement with ZMark Health for credentialing services and performing an assessment of their revenue cycle operations. Our knowledgeable team members will handle the practitioner enrollment from start to finish, preventing unnecessary delays in billing. Additionally, the ZMark Health team will measure how well the Fellowship House maximizes the amount of consumer revenue billed and how quickly the revenue is collected.

Fellowship House looks forward to working with ZMark Health to enhance and streamline credentialing and revenue cycle operations. Their expertise navigating the constantly changing payer landscape will help to keep time and resources focused on the agency’s mission.

About Fellowship House: As a result of deinstitutionalization, Fellowship House was founded in 1973 through a Community Support Program grant awarded to the Mental Health Association of Dade County. Patterned after the clubhouse model, it soon became independently incorporated and was designated as a demonstration project for the State of Florida by the National Institute of Mental Health. In the more than 48 years since its inception, Fellowship House has expanded to include vocational, social, employment, case management, outpatient services, residential programs and specialized intensive teams; serving approximately 1000 members (recipients of service) annually.
Fellowship House is widely recognized as a model for psychosocial rehabilitation. Fellowship House has a strong commitment to the provision of high-quality, culturally competent, patient-centered care.

About ZMark Health: ZMark Health provides innovative reimbursement solutions to support the unique needs of the clients we serve by striving to create a data-focused, collaborative and responsive environment that promotes the highest standards of integrity and quality. For more information, please reach out to Ashlee Seaman, Director of Marketing at ZMark Health:

Devereux Advanced Behavioral Health Partners with ZMark Health

Press Release

Devereux Advanced Behavioral Health recently signed an agreement with ZMark Health for consultative services to optimize insurance reimbursement.  With the goal of maximizing commercial insurance revenue, Devereux Advanced Behavioral Health and ZMark Health will work together to drive efficiencies and analytics throughout the revenue cycle.

“We are thrilled to partner with ZMark to ensure we are optimizing our relationships and business practices with commercial insurers to benefit the children, adolescents and adults we are privileged to serve,” said Devereux Advanced Behavioral Health President and CEO Carl E. Clark II.

“ZMark Health is excited to partner with Devereux on this important initiative”, noted Matt Zabolotny, President of ZMark Health.  “We welcome the opportunity to work with such a great team.”


About Devereux Advanced Behavioral Health: Devereux Advanced Behavioral Health is one of the nation’s largest nonprofit organizations providing services, insight and leadership in the evolving field of behavioral healthcare. Founded in 1912 by special education pioneer Helena Devereux, the organization operates a comprehensive national network of clinical, therapeutic, educational, and employment programs and services that positively impact the lives of tens of thousands of children, adults – and their families – every year. Focused on clinical advances emerging from a new understanding of the brain, its unique approach combines evidence-based interventions with compassionate family engagement.

With more than 7,500 employees working in programs across the nation, Devereux is a recognized partner for families, schools and communities, serving many of our country’s most vulnerable populations in the areas of autism, intellectual and developmental disabilities, specialty mental health, education and child welfare. Programs are offered in hospital, residential, community and school-based settings. They include: assessments; interventions and support; transition and independent life services; family and professional training; research and innovation; and advocacy and public education. For more than a century, Devereux Advanced Behavioral Health has been guided by a simple and enduring mission: To change lives by unlocking and nurturing human potential for people living with emotional, behavioral or cognitive differences.

About ZMark Health: ZMark Health provides innovative reimbursement solutions to support the unique needs of the clients we serve by striving to create a data-focused, collaborative and responsive environment that promotes the highest standards of integrity and quality. For more information, please reach out to Ashlee Seaman, Director of Marketing at ZMark Health:

Managing Consumer Out-of-Pocket Costs

— By Matt Zabolotny
Blog Post

As a Human Services provider, it is becoming increasingly challenging to manage consumer payment responsibilities from commercial insurances. Provisions under the Affordable Care Act are increasing the amount of money consumers must pay, and as a result commercial insurances are placing more financial responsibility on their members: your clients. It is essential to develop policies to communicate these expected costs to your consumers while prioritizing the financial health of your organization.

Consumers walk through your doors and present a wide variety of commercial insurances, each with unique benefits, copayments and deductibles to consider. Because of these complexities, your team needs to be prepared to effectively manage and communicate the financial responsibilities that fall to each client. Developing and consistently implementing a consumer-driven payment policy helps create a trusted relationship with your clients – a must for behavioral health organizations in a value-based care setting.

It is important to consider all outcomes when developing a consumer-centric policy, including a denial of service if an individual cannot cover their financial responsibilities. Working in conjunction with your care teams on policy formation ensures the best interest of the individual is at the forefront. Your business depends on how effectively you manage consumer payment responsibility as well as how consistently a policy is implemented. If you’re looking for a place to start, here are a few key tips:

  1. Develop Your Plan – Before you implement changes, you must develop a policy that fits the needs of your organization and the individuals you serve. Engage your clinical team in developing policies so everyone involved in consumer care contributes to, and understands, the new consumer-driven plan. When a question arises from a client, your team member can refer to your established policy to provide consistent answers and plan of action without question or hesitation.
  2. Train Your Team – Once a policy is developed, train your staff, particularly your team members working the front desk, on how to have effective payment conversations with consumers. This can be a difficult conversation and can take practice for your team to become confident and clear in their communication. Arm them with talking points, resources, and leadership support so they can effectively engage with your consumers and are able to collect payments at time of service with ease.
  3. Review Coverages – As mentioned, your clients will present a wide variety of commercial insurances. Behavioral health organizations need to mirror the practices implemented by many physician offices. Learn the individual’s current insurance status beyond “active” or “inactive.” Understanding their deductible, what services are covered, copays, effective dates, and if authorizations are required will prepare you for providing excellent customer service to your consumers. You will be able to answer questions, advise them on potential out-of-pocket costs, develop a payment plan, and give them peace of mind as you prepare them to receive care from your organization.
  4. Communicate, Communicate, Communicate – It is vital to communicate the financial policy to your consumers. You cannot overcommunicate this. Every current or future client should understand your financial policy to avoid potential confusion or frustration. Effective ways to notify clients include email, direct mail, posting policies on your website, placing signage at the front desk, and discussing it during the check-in process. Communicate your policy and stick with it. In the long run, your clients will appreciate your consistency and know what to expect when they arrive.
  5. Seek Outside Expertise – If you are not sure where to start or have questions on what will work best for your organization, ask for help! As a business, you can’t afford to continue with a financial policy that results in frustration from consumers and does not yield an increase in cash flow. An experienced, outside perspective can find gaps in current protocols and uncover where additional support is needed, allowing you to provide better client care and gain financial stability.

Zmark Health offers a variety of revenue management services and will give you the tools to manage the changing landscape of commercial healthcare insurances. Adapting to these shifting reimbursement models and updating your policies will allow you to keep pace with changes in the behavioral healthcare industry. Your expertise will give you a reputation as a knowledgeable, supportive organization providing top-rated customer service.

Learn how ZMark Health can help your business

Partner with ZMark Health and our experienced, compassionate, and knowledgeable team will find solutions to meet the needs of your practice. Whether you are falling behind on claims management or juggling the complexities of provider credentialing — we can help.

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