Hidden ways hospitals can save money

Scott Friesen, CEO of Newport Credentialing Solutions - Print  | 

2017 is predicted to be a challenging year for health systems and hospitals around the country, according to a recent blog post by Deloitte.

Increased financial pressures are expected due to changes to the payer mix, the move towards value-based care and uncertainty over a new administration in Washington. For those who continue to operate business as usual, a sound financial future will be challenging, if not impossible, to achieve.

Traditional cost cutting measure like labor reductions and supply costs are no longer enough. Hospitals and health systems must look for new ways to reduce expenses and increase revenue. This requires out of the box thinking by looking at often overlooked areas, like credentialing and provider enrollment.

Navigating the credentialing lifecycle

When you consider that a health system or large hospital has easily hundreds of providers, the time spent managing credentialing and provider enrollment is significant. A practitioner enters the administrative maze upon completion of their residency, when they are about to become an attending physician. Once they apply for privileges at a hospital, the credentialing life cycle begins. The credentialing team can spend months managing the primary source verification (PSV) process and other credentialing steps as they work to verify a provider's skills, training, education and licenses. Diligent follow-up is required along the way to ensure all verifications are complete and accurate. Next there is the provider enrollment process, which leverages essentially the same data gathered during the credentialing process, to secure a provider's participation in health plans and achieve approval to bill the plan for services rendered. Then there is re-credentialing/appointment (required every two to three years), re-attestation (required every 120 days), and re-validation enrollment (required every five years for Medicare).

Benefits linked to diminished redundancies in credentialing and provider enrollment are huge. Substantially reducing manpower and accelerating these processes means revenue can be collected faster. Furthermore, by streamlining data entry, the potential for errors is greatly reduced.

Fortunately, advances in technology enable health systems, hospitals, and CVOs to streamline credentialing and provider enrollment processes through workflow automation. Despite the benefits of cloud-based credentialing and provider enrollment technologies, many organizations don't utilize this technology simply because they are unaware it exists.

How it works

Credentialing and provider enrollment technology replaces siloed processes by utilizing workflow automation technology and remote data entry and information exchange portals. Information entered upfront during the credentialing process seamlessly transitions to enrollment once it is deemed ready by the credentialing team. The seamless process supports both hospital-based credentialing and enrollment functions. Teams work in unison through cloud-based workflow tools which maximize credentialing efforts and reduce the overall enrollment timeframes. The results are increased revenue and patient satisfaction. Technology also exists to automate load balancing which levels the workload among staff. As new providers are hired, the system determines which user has the least amount of work at that particular time and automatically assigns them a provider.

The benefits of reducing redundancies by allowing information to be seamlessly shared between credentialing and provider enrollment in one system can't be overstated. Administrative workloads and associated costs are reduced. Processes are faster and errors are avoided so providers can start billing faster. With budgets seemingly tighter than ever, streamlining credentialing and provider enrollment processes is an easy way to save (and make) money.

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