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Provider Enrollment: Survey Suggests a New Revenue Cycle Imperative

This blog post excerpts an article in the Q4 2015 issue of PX Advisor, our quarterly magazine designed to bring you thought leadership and best practices for improving the patient experience.

In this article, HealthStream examines the new environment for Provider Enrollment and its implications for healthcare leaders and presents new research collected in early 2015 by HealthStream from 130 credentialing executives throughout the U.S. The survey provides mounting evidence that Provider Enrollment needs to be given a much higher priority and viewed as a key driver of the hospital revenue cycle. Following are some survey highlights:

ONE: Provider “Enrollment” and “Credentialing” are two separate activities

HealthStream’s recent research indicates that healthcare executives are using the terms “credentialing” and “enrollment” interchangeably when it comes to the process of requesting enrollment of a provider in a health insurance network; however, credentialing and enrollment are very different functions.  In addition to becoming credentialed with a hospital, physicians must also apply to enroll in each health plan for which he or she will take patients. Typically, the physician will submit 20–25 separate health plan applications that may each be 30–50 pages in length and require 2-3 hours apiece to complete. Enrollment then can be defined as the tasks that support the process of becoming a Participating Provider in a health insurance network. The enrollment process typically takes 3–6 months to complete and must be repeated every time a change in provider status occurs—for example, it must be repeated even when a credentialed provider is changing medical groups.

TWO: Provider Enrollment is becoming a much higher priority

HealthStream interviews with 130 credentialing and provider enrollment experts in early 2015 showed that hospitals are heavily involved in the provider enrollment process. The net result, according to our survey respondents, is that more than six in ten say their hospital has placed a higher priority on improving the Provider Enrollment process in the past two years.

THREE: Provider Enrollment is now a Revenue Cycle Initiative

Credentialing executives no longer view Provider Enrollment as the back office function it once was. Almost two-thirds of the executives we surveyed now view Provider Enrollment as a part of Revenue Cycle Management.

FOUR: Reducing both the time it takes to enroll physicians and the associated administration costs are executives’ Top 2 Priorities for Improvement.

Our research shows that a high percentage of those who manage the Provider Enrollment function are struggling with the effectiveness and efficiency of their current process. Their top priorities in this area are to reduce the time it takes to enroll providers and to reduce the amount of resources that are expended to support Provider Enrollment.  As noted earlier, the financial repercussions of a Provider Enrollment process that is out of control can be highly detrimental. A healthcare organization can quickly face significant financial losses and high patient and physician frustration. The industry has fundamentally changed in the past several years, and healthcare leaders are acknowledging that it is time to elevate and improve the Provider Enrollment process accordingly. Is your organization giving the Provider Enrollment process the strategic importance it deserves?

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