White Papers

PROVIDER ENROLLMENT: An Emerging Revenue Cycle Imperative for Hospitals

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.

How is 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. We present new 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 in their organizations. We look at mounting evidence that this function needs to be given a much higher priority and 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

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