Healthcare merger and acquisition (M&A) activity is at an all-time high. For hospitals and health systems looking for new ways to stay competitive and expand their offerings, mergers and acquisitions have become a viable option.
While healthcare organizations have gotten better at post-M&A integration throughout the years, it is not uncommon for revenue disruptions to occur because of an oversight. One common area that is often overlooked is provider data management (PDM). When provider contracting and data management are not factored into M&A integration plans, hospitals and health systems put themselves in a costly financial position.
To avoid post-M&A revenue disruptions associated with provider data management integration issues (this includes credentialing and provider enrollment), consider the following.
Don’t manage data in silos. When provider data is stored in multiple locations/systems data can’t be shared or cross-accessed which makes it extremely difficult manage and review for accuracy. When working in disparate systems and data silos, it is very difficult to ensure that all provider data (which includes enrollment and credentialing data) is active and up-to-date.
For example, a centralized enterprise-wide PDM and credentialing system is particularly important when dealing with a health system’s tax identification numbers (TINs). If the acquired health system’s TINs are not converted to the acquiring health system’s TIN, the acquiring health system runs the risk of payments being stopped or routed to the wrong TIN. Either scenario can result in delays in cash posting which in turn can directly affect the financial life blood of the health system.
Create a Plan of Action. Strategic decisions must be made on how to best manage provider data and plans put into place to accelerate the PDM onboarding/integration process. Technology must also be evaluated to see if it is capable of handling a modern-day provider enrollment and data management program. This requires management of the entire provider credentialing and enrollment life cycle within one cloud-based database. This integrated digital backbone should facilitate the collection, management, and collaboration of provider data for every department/organization that shares this data. While each department may manage their respective tasks independently, utilizing an integrated digital backbone allows each department to holistically view and manage where their provider is in the PDM life cycle. Because access to information—regardless of location—is essential, a cloud-based technology is highly recommended.
Understand Your Resources. Do you have the necessary skilled resources in-house to handle the volume of providers being on-boarded? If the volume is too high to manage in-house, consider working with a credentialing and enrollment partner. Be sure the vendor you select has proven experience in provider enrollment post-M&A integration.
Managing each provider through the process of enrollment, privileging, provider and payer primary source verification as well as maintaining PAR status is a difficult and time consuming process. Doing so in a silo is nearly impossible. A centralized provider data management system will save staff significant time and help avoid potential revenue disruptions associated with poorly managed credentialing and provider enrollment data.
By Scott Friesen, CEO of Newport Credentialing Solutions