Monday, October 3, 2016

PUT DOWN THAT PEN! It’s Time to Go Digital with Provider Enrollment

Excerpt from an Interview With Lance Herbert, Vice President of Payer Credentialing & Provider Enrollment for Echo, A HealthStream Company

This article first appeared in Provider Advisor Magazine, Q1 2016

Why is provider enrollment getting so much more attention?

As the trend to employ providers continues, enrollment is now a top revenue cycle priority for healthcare organizations. In our recent white paper entitled PROVIDER ENROLLMENT: An Emerging Revenue Cycle Imperative for Hospitals, we stated that in 2014, for the first time, more than half of all U.S. physicians are employed. This represents almost a 75% increase in the number of employed physicians since 2000. As healthcare organizations hire providers, they must enroll the providers with payers; there is also an increasing expectation to shorten the onboarding times. Proper and efficient provider enrollment is the key to providers’ participation with insurance plans. The quicker provider enrollment is completed, the quicker healthcare organizations can be reimbursed for their providers’ services, which also results in the reduction of at-risk receivables.

High profile failures due to improper provider enrollment are catching the attention of healthcare organizations. In one prominent example, the State University of New York (SUNY) was forced to shut down Long Island College Hospital (LICH) after losing over $100 million. SUNY treated thousands of patients at LICH for free for almost two years due to failure to file the proper enrollment paperwork with insurance companies. While this may be an extreme example, it clearly points out the importance of proper provider enrollment and the severe financial implications that can result by ignoring it.

What are some of the provider enrollment challenges you are seeing among customers?

Our customers want to be able to leverage their resources, including their data. While data capture and information management is more of a necessity today, some customers wish to go a step further and analyze their statistics against benchmarks. This is an area that is generally lacking in the provider enrollment space, so we are investing in development of new tools that will help our customers overcome these challenges.

Nearly every customer wants to reduce the time frame required to enroll their providers. They realize that they can increase revenues by completing the enrollment process before their providers start seeing patients, which results in faster and potentially larger reimbursements. One key factor behind operating shortfalls at healthcare organizations that are adding employed providers is the unfamiliarity of hospital employees with the complexities of the provider enrollment process. Hospitals are finding that they are soon overwhelmed by the credentialing burdens they have assumed. It is critical for these organizations to identify solutions to help them manage these challenging tasks.

What are the functional changes you advise customers to make in terms of their provider enrollment processes?

For medical practices, the first change is to identify, define, and utilize a single, centralized location for provider data. Most of our customers have myriad data sources before they implement our software. This may include paper, spreadsheets, several databases, homegrown systems, filing cabinets, electronic files on multiple computers, and more. Using our system as the source of truth allows everyone in the organization to know exactly where their critical information resides and offers them quick and easy access to it.

For hospitals, we suggest integration of the credentialing, privileging, and provider enrollment process, platforms, and/or teams. We recently conducted a 2015 Provider Enrollment Survey of 130 hospital and health system credentialing executives across the U.S., and respondents strongly supported this change—89% of them stated that this integration was either somewhat or very important to their initiatives. Driving this desire to integrate is an increasing number of mergers and acquisitions, as hospitals are joining systems at an unprecedented rate, fueled largely by pressures from the Affordable Care Act and the pay-for-performance penalties of CMS regulation. A key driver of these consolidations has been the hope of increased efficiencies as economies of scale are achieved and processes are standardized throughout the enterprise. It now makes more sense than ever before to extend this standardization to the realm of provider credentialing, privileging, and enrollment.

What should we expect for the future of provider enrollment?

Provider enrollment has long been overrun by paper. Even in today’s digital world, credentialing departments are often filled with stacks of paper applications that must be completed, signed with wet ink, and mailed to payers. The future of provider enrollment will look different. The next phase, which has been in transition for the past several years, includes online applications in lieu of paper applications. This is becoming increasingly common, particularly with Medicaid enrollments. Following online applications, I anticipate we will begin to see EDI (electronic data interchange) between healthcare organizations and payers, including Medicare. Those who aren’t preparing for it will be left behind. We also expect organizations to begin using predictive analytics, allowing them to address issues before they occur rather than being forced to react to problems.

Another opportunity for bringing efficiency to the provider enrollment process is in the area of delegated credentialing, which is when hospitals or health systems take over the enrollment function on behalf of their health plan partners. In our 2015 Provider Enrollment Survey, over 80% of respondents indicated that delegated credentialing was either a somewhat or very
important initiative to their organization. We see this as a trend that is continuing to gain steam.

About Lance

Lance is Echo’s Vice President, Payer Credentialing & Provider Enrollment. He is the product owner of EchoOneApp, the company’s core provider enrollment solution, and he operates as the general manager for Echo’s office in Brentwood, Tennessee. Prior to this role, Lance joined SyMed Development, a HealthStream company in 2000, where he served in multiple leadership roles, most recently as Vice President, Sales & Marketing, during which time he significantly expanded market penetration and drove additional revenue growth while implementing methods to improve product installation, application testing, and upgrade distribution.

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