Wednesday, November 9, 2016

3 Facts About Provider Enrollment That Can Affect Your Credentialing Process



Guest Post by Meg Terry, Senior Vice-President of Corporate Strategy; Echo, A HealthStream Company


Change is inevitable, progress is not.  Healthcare organizations are certainly not immune to change and doing business the “old” way makes it harder to progress. Traditionally, provider credentialing and provider enrollment have operated as separate functions within a hospital or health system. Organizations that are successful have integrated these two processes in order to more efficiently manage the organization’s revenue cycle for continued growth.

Listen to our webinar – Top 10 Provider Enrollment Survey Result Discoveries, and we’ll walk you through the facts about provider enrollment that can affect your credentialing process and why change is necessary.

Fact #1 – Provider Enrollment is a Critical Component of Provider Onboarding


A growing number of U.S. doctors are leaving private practice for hospital employment and only one-in-three will remain independent  by the end of 2016. This industry shift has placed a new burden on credentialing and enrollment professionals to integrate their activities and streamline the process. While the hospital may be paying a salary to a new physician beginning on Day One of employment, it cannot start billing and receiving reimbursements for services until the physician has been completely onboarded. This includes both finalizing his or her credentialing as well as enrolling the provider in commercial and government health plans.

Regardless of when a provider starts working at a hospital or medical group, until the health plan awards the provider an effective date of participation claims may be denied or held. Lost revenue can result in hundreds of thousands of dollars in a matter of weeks.

To avoid payment interruptions, it’s important that you have a system in place that can initiate both the credentialing process and enrollment process at the same time so there is minimal time delay between approving a provider’s credentials and completing the enrollment process.

Fact # 2 – Efficient Revenue Cycle Management Depends on an Integrated Enrollment and Credentialing Process


Echo's latest research conducted in conjunction with Decision Health indicates that provider enrollment professionals are realizing the financial impacts and inefficiency of manual provider enrollment processes. One of the biggest challenges faced is collecting all the provider data necessary to submit payer applications. For example, manually submitting a Medicare application can take up to 90 days to process. Using an automated online process that integrates with your credentialing database can accelerate the enrollment application process saving you time and money.

On average, about 18 payer applications need to be processed for every provider. If your facility has 20 providers and you spend about one day each collecting data and processing their enrollment applications, you spend roughly 3000 hours a year just processing paperwork! Let’s say that a busy provider bills around $5000 a day. So for the 90 days that this provider is not fully enrolled, you are potentially losing $450,000 in billable revenue.

In contrast, working in tandem with your credentialing system, the pertinent provider data is already collected and the 90-day process can be cut to 10 days or less, reducing your lost billable revenue significantly and saving you time.

Fact # 3 – Happy Providers, Happy Life!


Seriously, physician retention is another important topic. Physician satisfaction equates to success and continued growth for your healthcare organization. This ultimately translates into better patient care and quality outcomes as physicians are in an environment where they can more readily focus on delivering patient care rather than taking care of administrative needs. What better way to promote strong physician retention that to make “standard” employee practices simple and easy?

With regards to enrollment and credentialing, providers need a streamlined, turn-key system where they are only asked for information one time. Collecting all data required once and entering it in one place makes the pre-employment process go smoothly; less time asking for and handling duplicate information and mitigating the chances of entering incorrect data with a second process. Having a centralized “portal” for providers gives them a set place to view all of their activities and see where they are in the credentialing and enrollment process.

Hopefully you can see from these 3 facts of just how interconnected provider enrollment and credentialing are. Progress can be made by integrating both functions into one automated system, so you can make your provider enrollment process less time consuming, maximize resources, and better control your revenue cycle. What to learn more? Click here.

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