Provider Enrollment Solutions Vital for Hospital Revenue Cycle Management: White Paper

For years, hospitals have considered provider enrollment a back-office function. It is separate from the provider credentialing process but shares many of the same characteristics—it is complicated, redundant, and time-consuming. The enrollment process may cause frustration to providers and administrative staff alike, but it is not traditionally considered a strategic function worthy of attention or added resources. However, a series of new industry developments has greatly escalated the importance of the enrollment process. Unfortunately, many healthcare leaders are only realizing this as they incur significant and surprising revenue losses, and the result is that hospital leaders are now scrambling for better solutions to this new administrative nightmare.

A Common Provider Enrollment Scenario

You acquired a new 10-physician practice on January 1st. All 10 providers immediately began seeing patients on your behalf, and your hospital began paying them their agreed-upon salaries and benefits. It is now April, and none of the physicians have yet completed the full provider enrollment process. The physicians have collectively generated almost $4 million in charges for which your hospital will never be reimbursed by payers, and you are facing a stunning write-off for the first half of the year.

Has a version of this scenario played out in your organization? If so, you are not alone.

How Are Provider Enrollment and Credentialing Changing? 

In this White Paper, HealthStream examines the new environment for Provider Enrollment and its implications for hospital and health system leaders. This paper includes research collected in early 2015 by HealthStream from 130 hospital and health system credentialing executives throughout the U.S. who indicate that improving the provider enrollment function is a high priority for their organizations. We look at mounting evidence that this function needs to be given a much higher priority and needs to be viewed as a key driver of the hospital revenue cycle.

This paper includes: 

  • 10 findings from the 2015 provider enrollment survey
  • A cautionary tale: failure to ‘credential’ doctors lost major insurance monies
  • Provider “Enrollment” and “Credentialing” are two separate activities
  • The future includes new requirements and new opportunities to improve Provider Enrollment

Complete this form to download the paper.

April 1, 2021