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12 Major Findings about Healthcare Provider Enrollment

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 Verity™, a HealthStream Company, examines the current and changing landscape of provider enrollment and the implications for medical groups, hospitals, and healthcare organizations. We present our 2017 research findings collected by Verity™ from 505 credentialing and provider enrollment professionals throughout the U.S.

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 Verity™, a HealthStream Company, examines the current and changing landscape of provider enrollment and the implications for medical groups, hospitals, and healthcare organizations. We present our 2017 research findings collected by Verity™ from 505 credentialing and provider enrollment professionals throughout the U.S. 

Survey results describe an industry undergoing change in response to shrinking revenue. Healthcare leaders envision an enterprise data solution that is used by recruitment, credentialing, provider enrollment, and others involved in provider onboarding in order to maximize efficiency in achieving the goal of timely credentialing and enrollment, as well as continuously updated provider data.

MAJOR FINDINGS OF THE 2017 ANNUAL REPORT ON PROVIDER ENROLLMENT

1. Most organizations indicate their provider enrollment process is “adequate” and concede that improvement opportunities exist.

2. Almost two-thirds of organizations indicate that improving the provider enrollment process is a higher priority than one year ago.

3. By far, the top priority for improvement is reducing the time required to enroll a provider.

4. Approximately two-thirds of those who manage the provider enrollment function for their organization also manage credentialing functions.

5. Most organizations have an opportunity to improve efficiency and accuracy by merging their credentialing and provider enrollment functions.

6. The typical organization handles a variety of enrollment activities for more than 100 providers who each participate in 10-29 health plans.

7. While most organizations are using commercial software for their provider enrollment or credentialing, many continue to use less efficient, more error-prone tools.

8. There is high potential for error in the provider enrollment process of most organizations.

9. Organizations do not appear to be using the PECOS system and its surrogate program to their fullest potential.

10. Most organizations make an initial contact with payers within one month of application submission; subsequent follow-up is made every 1-2 weeks.

11. Just under three-fourths of organizations use CAQH for payer enrollment.

12. About half of organizations are using delegated credentialing for at least seven or more payers.

About Verity

Verity, a HealthStream Company, delivers enterprise-class solutions to transform the healthcare provider experience for healthcare organizations and providers. We currently serve over 2,400 hospitals and 1,000 medical groups in the US. Verity resulted from the merging of Echo and Morrisey, representing over 75 years of industry experience, becoming the leading credentialing, enrollment, and privileging companies in the United States. HealthStream, (NASDAQ: HSTM), based in Nashville, TN, is our parent company, supporting us through innovation, investment, and the development of market-leading solutions. Verity has over 200 employees spanning headquarters in Boulder, CO and satellite offices in San Diego, CA, Brentwood, TN, and Chicago, IL. 

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