From Start to Finish: Streamlining Provider Lifecycle Management to Deliver Value Back to Healthcare Organizations

While processes like enrollment and credentialing may often seem more administrative in nature, they have very real impacts on patient care and safety, as well as a hospital or health system’s financial performance.

Across healthcare, organizations write off sizeable amounts in claims denials each year, and improper credentialing can lead to significant harm for patients and hospitals alike. Financial liability related to poor process administration varies, but the associated revenue and reputational risks can lead to deep-rooted and long-term problems for any organization. 

Historically siloed approaches to enrollment and credentialing have also created technology gaps and inefficient processes riddled with duplicative (and often conflicting) provider data to support administration and analysis.

On top of existing institutional issues, payer enrollment has become increasingly complex due to more stringent regulatory standards, a rapidly changing technological environment, administrative overhead costs and lack of uniformity among payers. Underlying administrative complexity has been further amplified by a multitude of state, federal and payer-specific requirements, making effective management of organizational obligations cumbersome and time-consuming.

In today's ever-evolving healthcare landscape, organizations must stay ahead of the curve when it comes to managing provider populations and mission-critical business data. It’s time for the healthcare industry to look for a more comprehensive and sustainable solution to provider management.

How Centralization Can Simplify Healthcare

While 2021 Advisory Board Trends in Hospital Revenue Cycle Performance Report found that denial write-offs have decreased for some hospitals, the pandemic has had a lasting impact on staffing levels for many, with furloughs, burnout, and cost reduction policies leaving organizations' revenue-related functions vulnerable to poor performance.

In the report, Advisory Board also acknowledged that many health systems are combatting vulnerable processes with increased investment in automation and outsourcing, highlighting that “outsourcing has grown out of pricing and costs constraints exacerbated by the pandemic.”

This shift is not without precedent. In an earlier report, Advisory Board underscored that centralizing key revenue cycle functions can help drive down costs, due in part to the high operational costs associated with maintaining these functions.

Effectively, streamlining the back office serves the dual purpose of collecting revenue more efficiently while strategically containing the cost to collect it in the first place.

Centralization Requires Dedicated Technologies and Services

Organizations have an opportunity to systematically “bust” silos by leveraging a single platform built on integrated processes and a shared data model. This approach can provide cross-functional teams with a centralized view of provider populations and payer contracts — including all in-process and upcoming tasks — making it easier to track and manage information.

Additionally, a single "source of truth” allows stakeholders to manage enrollment and credentialing processes with an enterprise lens, helping them to better align resources, introduce opportunities for improved processing times and help coordinate on-boarding tasks. Some providers even offer outsourced credentialing services to help reduce the burden on already strained healthcare workers and address operational vulnerabilities.

A more streamlined process can more effectively align resources and reduce the time, effort and financial drain lost to the burden of duplicative work and administrative waste for providers and administrators, while also helping healthcare organizations improve transparency, data reliability and resource allocation.

Streamline Key Processes with RLDatix Advanced Provider Lifecycle Management

With Advanced Provider Lifecycle Management, organizations benefit from a comprehensive, centralized approach that allows stakeholders to manage provider data in one place, simplifying relationship management with a wide range of entities and networks across multiple payer contracts. This new architecture represents the first of its kind in the industry, enabling direct connections between primary source-verified record details and payer enrollment tasks through natively integrated solutions.

This seamless integration between credentialing tasks and the specialized payer enrollment software enables teams to spend less time on payer updates and duplicative data entry, and provides greater visibility into provider information, more efficient IT investment, additional control over affiliated networks, and more timely and accurate reporting.

As a result, healthcare organizations can unlock transformative cost savings and reimbursement benefits by mitigating operational risks that lead to fines and network overage charges, streamlining provider onboarding efforts, and reducing the time spent on application creation, validations and updates to other administrative systems. In some cases, more efficient provider onboarding can even lead to improved margins through enhanced revenue recaptures coupled with the potential reduced operating costs.

All of this serves to help teams leverage their resources more effectively and get back to what matters — ensuring safety and efficiency for patients, providers and everyone in-between.

Interested in learning more about how your team can take full advantage of the efficiencies and insights offered by an integrated provider lifecycle management solution? Reach out to RLDatix today.

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