Wednesday, March 22, 2017

The Inefficiency of Manual Provider Enrollment - How You Can Start Saving Today

Today’s payer applications are very complex, lengthy, and redundant. The sheer amount of forms to be completed for each provider can be overwhelming and time-consuming for enrollment professionals. A recent New England Journal of Medicine editorial claims that a coordinated national system of credentialing would save providers nearly $1 billion in administrative costs, and further savings could be achieved if processes for establishing payer–provider contracts were also standardized and conducted electronically.

The average healthcare organization processes 4500 enrollment applications annually with at least 18 applications per physician on staff. Provider enrollment professionals tell us that their biggest challenge is the volume and length of enrollment forms. In addition, complexity of the forms and collecting all the necessary provider data create barriers to timely provider enrollment.

Provider enrollment personnel indicate they spend most of their time on initial enrollment and subsequent revalidation of the providers they represent. Unfortunately, most provider enrollment offices receive less than a 2-month notice to begin enrolling a provider prior to his or her start date. The problem with this is that is typically takes 3 to 6 months to complete the enrollment process so it is very likely that the healthcare organization will lose revenue during this onboarding time. Providers will not be allowed to charge patients and receive reimbursement until the enrollment process in complete.

Our research shows that 56% of provider enrollment professionals use some type of software solutions to help automate their processes (ref), but a high number of provider enrollment professionals are still relying on spreadsheets and other manual processes to do the job. Why risk losing significant amounts of time and money from inefficient processes?

Given the new payment reforms that are coming with downward pressure on revenues, upcoming changes in physician reimbursement, revalidation, and many other initiatives, is your hospital, healthcare organization, or medical group ready to thrive in this new environment?

Utilizing a software program that allows you to have access to preformatted payer forms, and direct integration to CAQH, PECOS and other state enrollment sites can save you both time and money. As an example, with an organization of 250 providers and 18 applications per provider to submit, Echo can help you save over $200,000* in annual costs to complete the application process.

Why not get started today in improving the efficiency of your provider enrollment processes. Contact us today to learn how.

Reference - PROVIDER ENROLLMENT: Revenue Cycle Impact and Woeful Inefficiency Make It a High Priority (DecisionHealth – HealthStream 2016 report)

*Will vary by organization

Wednesday, March 15, 2017

Are Your Patient Care Areas Receiving Timely Provider Clinical Privileging Information?

Industry practice is to make information about what practitioners have been granted privileges - and the specific privileges that have been granted – available to patient care providers. When necessary, nurses’ stations, surgery scheduling and other patient care areas need to confirm a practitioner's privileges.  In the past, paper copies of privileges for each practitioner where sent to these patient care areas. Inevitability, these hard copies ended up being filed in big clunky binders.  A common problem that arises is how do you know that this is the most up to date privileging information?

Today, credentialing software exists that easily enables patient care providers to look up privileges electronically. It is the responsibility of the credentialing/privileging department is to make sure that the privileging information is current. When privileges are granted, the provider’s information should be updated so that current privileging data is available.

The responsibility of patient care areas is to access the privileging information as appropriate.  There should be a patient care policy that identifies how privileging information is accessed, when it should be accessed and what a patient care provider should do if it is identified that a practitioner intends to exercise privileges that have not been granted.  All of this should be covered during orientation for new patient care employees and as well as during annual updates.

In addition, it is likely that during and accreditation survey a surveyor will ask a nurse or surgery scheduler to demonstrate the method for accessing privileges and that is how the system will be determined to be effective - or not. Don’t get caught trying to explain the effectiveness of your privileging look up process. Make sure you have a robust system that is updated on a regular basis and tied to your organization’s credentialing system.

Echo’s Provider Privilege Lookup portal can eliminate the time-consuming copying and distribution of paper clinical privilege lists. Share real-time clinical privilege information with others in your organization that need access. Pages can be created with easy-to-use search capabilities (i.e. by physician or privilege). The information displayed is tailored to your exact specifications and may include physician photos, staff status or department.

Don’t get caught in an accreditation nightmare. Click here to learn more about updating access to your clinical privileging information.