Archived Publications eBook: The Dollars are in the Details | Page 13

TRADITIONALLY, HOSPITALS, HEALTHCARE ORGANIZATIONS,
and medical groups have viewed provider enrollment in health plans
as a back-office function, lacking strategic importance. More recently
however, a number of changes in the industry have caused this function
to be viewed in a much more important light.
First, hospitals, healthcare organizations, and large medical
groups have employed providers in record numbers, taking
on the responsibility of their credentialing and provider
enrollment. Many of these employers initially underestimated
the importance of a timely credentialing and enrollment
process and incurred significant financial losses as a result. Third, hospitals, healthcare organizations, and medical groups
are actively seeking solutions that will improve efficiency
and revenue cycle management. More than eighty percent
of medical services professionals in our recent survey indicate
that their top priority is to reduce the time it takes to
enroll providers.
Second, credentialing and enrollment processes are woefully
inefficient in light of current volumes and reporting demands.
Many medical service professionals continue to use manual
processes to submit applications and associated documentation
and lack the tools they need to meet demand. In this article, Echo, A HealthStream Company, and
DecisionHealth present new research collected in
early 2016 from nearly 300 credentialing and provider
enrollment professionals. We think you will be surprised
by some of our findings.
PROVIDER ENROLLMENT GAINING IMPORTANCE
While hospitals, health care organizations, and physician
groups may employ a provider on his or her first day of
employment, they cannot receive reimbursement from a
health plan for services rendered until the provider has
been fully credentialed, privileged, and enrolled in the health
plan. Moreover, most health plans will not retroactively
reimburse for services performed by these providers
prior to full credentialing and enrollment.
Healthcare organizations are incurring losses as they buy
physician practices and take over their management. One
key factor behind these high losses 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 not surprising that results from the Echo/DecisionHealth
2016 survey show that hospitals, healthcare organizations,
and medical group practices are placing a higher emphasis
on provider enrollment than in years past.
Nearly 70% of respondents to our survey say that improving
the provider enrollment process has become a higher priority
in the past year. This represents an almost ten percent
increase over similar research conducted by Echo in 2015.
Q. In the past year, has improving the provider
enrollment process become a higher priority,
lower priority, or remained unchanged as a
priority for your organization? (Base = 282)
69.2%
Higher Priority
24.8%
Unchanged
Lower Priority 3.2%
Don’t Know 2.8%
0
20
40
60
80
HealthStream.com/contact • 800.521.0574 •
Reprint from SUMMER 2016 Provider Advisor
13