Summer has officially begun, and employees across the country are heading out on vacation. For the healthcare industry, which operates business as usual regardless of the season, inadequate staffing coupled with poor management of business-critical processes often negatively impact a hospital's revenue.
Consider, for example, credentialing and privileging which necessitate on-going management and monitoring. These functions require proactive and ongoing monitoring of licenses, sanctions, exclusions and much more. These processes cannot wait for someone to return from summer break as the financial repercussions of incorrectly enrolling providers with payers are huge. If a provider is not enrolled or credentialing expires, a provider will not be paid for the procedures they perform.
To avoid lost revenue during summer months, consider the following:
• Maintain a scheduled approach to follow-up during all application processes – health plans can take over six months to enroll a provider at times, but there may be additional information that is needed to complete the provider's enrollment. Pro-active and repeated application follow-up is the best way to ensure that the application is consistently moving through the payer's enrollment process.
• With each payer application requiring different criteria, it is easy for tasks to fall through the cracks. Manually monitoring this process can be a very time-consuming and complex endeavor. Having the right cloud-based technology will play a pivotal role in preventing these tasks from falling through the cracks. Using cloud-based dashboards and Key Performance Indicators (KPIs) is key to staying on top of all of the moving parts of the constantly moving parts of the credentialing life cycle.
• Demographic and primary source documentation should be housed in a central, cloud-based repository and available for review on a real-time basis. Cloud technology enables organizations to extend access to enrollment information to others within an organization such as scheduling. With up-to-date information in hand, if discovered during the time of scheduling that a provider is not enrolled with the patient's insurance, the procedure is not scheduled and lost revenue avoided.
• For mid to large size healthcare organizations, especially those with multiple locations, managing credentialing and enrollment in-house can be a time-consuming and costly endeavor especially during peak vacation times like summer and winter holidays. With the right enrollment partner, outsourcing can be a much easier and more cost-effective option than having to look for an employee's replacement while they are out on vacation.
Whether managing enrollment in-house or working with an outsourced enrollment partner, having the right processes and cloud-based tools is essential regardless of the season. Lost revenue due to provider enrollment eligibility issues can be significantly reduced, if not eliminated with real-time access to current information regardless of who is – or isn't – in the office.
Credentialing and enrollment are critical business processes within the hospital, physician and allied health provider revenue cycle. When not managed properly they can, and will, negatively impact a healthcare organization's revenue. If a provider is not enrolled correctly, they will not be paid properly. Furthermore, incorrect or poorly managed credentialing and enrollment processes may also put a practice at risk for compliance violations and even liability for false claims.
Allyson Schiff is Vice President of Operations at Newport Credentialing Solutions, the nation's premier provider of cloud-based software and IT enabled services dedicated to the credentialing life cycle. Allyson can be reached at Allyson.Schiff@newportcredentialing.com
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