For organizational guidance – A compass or a GPS?

Managing the revenue cycle for healthcare organizations is a complex endeavor.

To navigate the many variables associated with successful reimbursement, revenue cycle management is becoming increasingly reliant on data analytics. Understanding which data points to focus on is key to obtaining operational and financial excellence. Just like using a GPS navigation tool is more precise and easier to use than a hand-held compass, managing the complex revenue cycle requires the same kind of advanced tool-set that can normalize and present data in a precise and easy to use manner.

While there are many moving parts in the healthcare revenue cycle, a frequently overlooked component is provider enrollment. Provider enrollment is often viewed as a rigorous and time consuming process of managing provider data to get a provider enrolled with insurance payers as quickly as possible. For organizations that lack detailed insight into provider data, they are unable to successfully measure the impact that provider enrollment has on their overall revenue cycle.

A compass or a GPS?

Similar to a compass, many legacy provider credentialing/enrollment systems offer tools to follow the general direction needed to manage a provider’s credentialing. Many provide a database to track provider data and the functionality to process provider applications. Some even offer basic reminders as to what step to take next. But while it’s important to understand where a provider’s application is in the credentialing life cycle, most legacy systems do not offer data driven insight into the impact of provider enrollment on their revenue cycle. Without understanding how much revenue may be at-risk with outstanding enrollments, it’s difficult to know the impact on revenue cycle. As a result, many organizations are left feeling lost (in the woods).

A simple example to consider; a legacy credentialing system (compass) may identify 90 pending applications with one payor that are 180 days old, and 40 applications with a second payor that are 45 days old. Based on this data-set, many organizations will prioritize the 90 applications at 180 days and develop processes for the credentialing staff to follow to work the 180 day old applications. However, organizations with the advanced software capabilities (GPS) to link their gross charges to their in-process enrollments are able to process this data with significantly greater impact. What if the at-risk revenue of the 40 outstanding applications is significantly higher — even double — the 90 outstanding enrollments? Similar to working accounts receivables (AR), the seasoned revenue cycle administrator will work the largest invoices first, followed by the lower invoices; in provider enrollment the same concept applies. In this example, by using advanced technology to understand which enrollments have the greatest number of charges associated with them, the seasoned credentialing administrator is able to maximize their time by working on enrollments with the highest financial impact.

The value of credentialing analytics

Analytics enable organizations to leverage the vast amount of data they have to make more informed business decisions. While analytics are widely used across many areas of healthcare, the value of analytics within credentialing and provider enrollment is just now being realized as more healthcare organizations seek additional opportunities to reduce cost and maximize revenue. By viewing credentialing as a component of the revenue cycle, organizations only then begin to understand how limited the data is in many long-used legacy credentialing systems.

Newer cloud-based provider enrollment software platforms, and the analytics they provide, are growing in popularity over legacy systems. This popularity is due in part to their ability to precisely guide and focus credentialing teams to the most critical components of the credentialing and revenue life cycles. As with using a GPS navigation tool, as opposed to a compass, using the right provider enrollment analytics platform will get you to your objective of financial success in the most expedient and successful manner possible.

By Patrick Doyle, Senior Vice President, Newport Credentialing Solutions

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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