Credentialing and Provider Enrollment for 2018: General Survey Conclusions
January 24, 2018
Medical groups, hospitals, and healthcare organizations are facing an uncertain healthcare environment, escalating costs, and declining reimbursements. These organizations continue to seek strategies and solutions to decrease costs, increase revenue, and accelerate their provider enrollment process in order to obtain more timely reimbursement.
It is against this backdrop that VerityStream examined the current and changing landscape of provider enrollment and the implications for medical groups, hospitals and healthcare organizations. We present our research collected in early 2017 from 505 credentialing and provider enrollment professionals throughout the U.S. who indicate that creating efficiency and automation are higher priorities in their organization than in recent years. Here are some general conclusions we draw from the survey results:
Focus on the Revenue Stream
Healthcare leaders are increasingly being challenged to improve the revenue stream. Efficient and timely provider enrollment is a high priority to improve their organization’s bottom line. Many credentialing and provider enrollment professionals are being required to develop more efficient methods to complete the complex provider credentialing and provider enrollment processes. This typically means that these credentialing and provider enrollment professionals will need to incorporate the use of advanced technology in their daily work. Additionally, these professionals have the added pressure of making sure provider data that is made available via public-facing directories is continuously accurate—a very difficult task.
A Clear Need for Improvement—Data Is an Issue
The valuable survey data provides a clear message of the industry challenges and crucial information to assist in setting strategies to create solutions to success. Many of those who completed the survey report their organization’s provider enrollment processes need improvement. Nearly a quarter report that they require significant and immediate improvements. This is the industry’s call to action to develop processes which incorporate innovative methods to decrease practitioner onboarding timeframes with resultant bottom-line financial benefit, improved practitioner experience, and availability for patients to access practitioners through accurate public-facing directories. Note that the data shows that although 72% of respondents use vendor provided software for credentialing and provider enrollment, 70% report that there is manual communication between departments— which means that maintaining timely and accurate data is almost impossible.
Shrinking Revenue Necessitates Changed Solutions and Enterprise-Level Focus
The research and analysis of data demonstrates an industry undergoing change in response to shrinking revenue. Healthcare leaders are envisioning an enterprise data solution that is used by recruitment, credentialing, provider enrollment, and others involved in provider onboarding—in order to create the maximum efficiency in achieving the goal of timely credentialing and enrollment, but also the goal of continuously updated provider data.
- Healthcare organizations are making decisions to merge credentialing and provider enrollment operations under a single reporting function. One fifth of the organizations surveyed have merged in the last 24 months with reports of others putting plans in place to complete the transition within the next year or two. Centralizing practitioner onboarding under the same authority provides a method to improve efficiencies with aligned workflows supported by singular departmental goals.
- Engaging and/or integrating recruitment into the credentialing and provider enrollment process will decrease the possibility attributed to late notification of start date which continues to be a problem for healthcare organizations. Eighty-one percent of survey respondents noted that they have less than 90 days’ notice that a provider must be credentialed and enrolled—and 40% have less than 60 days’ notice. Despite best efforts, it is likely that these shorter timeframes will become the norm, and credentialing and provider enrollment professionals will need to use automation to get their work done faster. Additionally, decision-makers will need to revise the way that they work in order to close the loop on making credentialing and enrollment decisions.
- The data confirms that in addition to completing provider enrollment functions, they additionally have accountability for credentialing, medical staff, provider onboarding, and financial functions. Financial functions would be considered revenue cycle, billing, claims, and collections. The integration of payer enrollment function and accountabilities contributes to efficient provider onboarding processes supported by innovated software solutions.
VerityStream delivers enterprise-class solutions that are transforming credentialing, enrollment, privileging, and evaluation for healthcare organizations across the United States. We currently serve over 2,500 hospitals and 1,300 outpatient care settings in the U.S. including ambulatory surgery centers, urgent cares, and medical groups. VerityStream and our solutions resulted from the merging of Sy.Med, HealthLine Systems, Morrisey, and CredentialMyDoc representing over 75 years of industry experience. HealthStream, (NASDAQ: HSTM), based in Nashville, TN, is our parent company, supporting us through innovation, investment, and the development of market-leading products. VerityStream has over 225 employees spanning headquarters in Boulder, CO and satellite offices in San Diego, CA; Nashville, TN; Chicago, IL; and Savannah, GA.