Tidying Up Provider Enrollment & Credentialing
Applying The KonMari Method with a Focus on Efficiency
It’s 2019. In the midst of upcoming reimbursement changes in healthcare, hospitals and hospital systems are attempting to systemize or centralize their commercial and government payer credentialing and provider enrollment processes. Efficiency is the key! Writing off perfectly good service claims that cannot be processed due to provider enrollment delays or processing issues is unacceptable, especially when every dollar counts.
Consolidate. Eliminate duplication. Create one source of truth. Communicate. Recruitment and Onboarding work hand-in-hand. Communicate with reimbursement teams. Avoid payment delays. Streamline. Streamline. Streamline.
That’s why it is important to centralize provider enrollment and credentialing.
With a centralized initiative comes centralized accountability for all recruitment processes related to enrollment and reimbursement, ensuring efficient and accurate handling. The goal is to provide excellent healthcare services to the community, right? We cannot sustain the desired care provision levels without proper and timely reimbursement. Efficient, centralized enrollment is important as well where staff growth is anticipated or when plans include the acquisition of other service lines, hospitals, or providers.
We agree that a centralized approach is more efficient and practical than silos of groups handling the same processes in various ways, under differing methodologies and guidance policies. When groups are handling the same process in this manner, often times, it is handled with inconsistent and minimal communication, that inevitably leads to unnecessary finger pointing and delays in cash flow. Centralization is a good idea and the only logical option for many large health systems.
Beware, centralization of this service line is complex and often times a highly political endeavor.
It is imperative that centralization of provider enrollment and credentialing is handled with care; open lines of communication must address every aspect of the credentialing, enrollment and reimbursement processes.
Scrutinize the processes currently in place to create a well-oiled machine. Begin with your talent/physician recruitment team. We receive countless panicked calls from providers whose claims are being rejected because of problems with their current enrollment and credentialing practices. We then have to attempt to negotiate payment after the fact, which is never simple or easy. Another common problem occurs when a physician’s enrollment process must be expedited because that physician started caring for patients without having completed enrollment and claims cannot be submitted for payment because one group hasn’t told the other about a new addition to the staff. Months later, write -offs in the thousands happen because of one misstep in communications. How about surgery having to be postponed because the surgeon is not yet in-network? That happens too.
The Advis Group recommends that you start at the beginning, with the recruitment process. Ask yourself these questions: Who is involved with new staff negotiation? As soon as you think a new member is coming on board, the designated credentialing team needs to receive notice of all necessary information and start the process.
Continue to analyze your current structure and procedures. Do you have the same folks handling commercial credentialing and hospital or group medical staff credentialing? If there are two different groups, do they communicate on a regular basis? Do you use credentialing software or a central database?
Are you currently outsourcing any of these services? Perhaps outsourcing is a viable option for your new centralized model? Leave your talented in-house staff to medical staff credentialing and recruitment.
Is there a separate team negotiating your commercial contracts? Do they communicate with your commercial credentialing team over contract changes? Are your finance teams reporting A/R issues related to provider enrollment or commercial credentialing issues or delays?
So many questions! We have the answers! Call The Advis Group to assist in centralizing your provider enrollment and credentialing needs.