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Physicians: Provider Enrollment Must Go Digital

The Q1 2016 Provider Advisor is focused squarely on the onboarding process and how providers are affected by it. This post excerpts a Q&A with Echo’s Lance Hebert about provider enrollment.

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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 timeframe 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.

Can you share some specific examples of how customers have improved their provider enrollment processes?

We have a pediatric customer in Florida that struggled with onboarding providers. Specifically, they had a hard time collecting their providers’ data, which was accomplished by sending them a lengthy paper application to fill out by hand. There were no checks and balances, no way to see progress, and no way to require fields. In addition, the providers’ handwriting was challenging to read, and the system resulted in duplicated data entry, missing data and errors. We worked with the customer to develop a secure online portal through which providers could electronically submit data directly into our software while adhering to data requirements defined by the customer. The tool, now called NoPen, is today utilized by dozens of our customers to expedite and control the initial phase of provider enrollment.

We have a cutting-edge physiotherapy customer that leverages nearly every optional tool we offer. They have customized screens and reports within the software, have integrated our database with other systems in their organization, and continuously challenge our software and customer support team. They are the definition of “power users,” and through their use of our software have been able to reduce their provider enrollment turn-around time from 92 days (their average time pre-implementation) to less than 10 days (today).

We also have a regional hospital based in the Midwest that has had tremendously positive results with our software. They moved provider enrollment from a paper-based system to our electronic system, which facilitated substantial improvements in efficiency, FTE expenses, and outstanding receivables. In only 8 months, they improved their aging receivables due to untimely enrollment by 97%, reducing the outstanding amount from $350,000 to $12,000. In addition, physician satisfaction improved due to a new automated system that reduced the time to complete enrollment applications and eliminated redundancy in completing the same information across multiple applications.

What’s 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.

 

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