The rise of healthcare consumerism has significantly elevated the importance of patient satisfaction.
As deductibles continue to climb, patients have become increasingly more vocal in their care and choice of provider. If they aren't happy, they will take their business elsewhere, often leaving a negative online review in the process.
As hospitals and health systems continue to look for new ways to improve patient satisfaction, one area that is typically overlooked is provider enrollment. While commonly viewed as a back-office function, provider enrollment can have a significant impact on patient satisfaction and the overall hospital experience. If a provider is not enrolled with their respective provider, the patient:
• May not receive in-network care,
• Will not be protected from out of pocket expenses, and
• Runs the risk of being scheduled with a provider that is not familiar with their prior medical history which could impact their level of care and even put the patient at medical risk.
The ramifications of a poorly managed enrollment process are very real. When not managed properly, patient satisfaction can be negatively impacted. In addition, there are financial implications for healthcare organizations. Fortunately, with the right cloud-based technology and domain expertise, these provider enrollment problems are relatively easy to solve. To avoid common enrollment-related mistakes, consider the following.
• Avoid unnecessary patient dissatisfaction by validating that the provider is participating with the patient’s insurance at the time of scheduling. Validating provider participation with the patient’s insurance should occur alongside the insurance verification and authorization process. If a provider isn’t enrolled with the patient’s insurance, inform the patient immediately and offer alternate providers who are participating with their insurance plan.
• At the point of scheduling and insurance verification, ensure schedulers have access to real-time provider enrollment participation status. This process should be enabled by real-time, cloud-based enrollment validation technology, not “cheat sheets,” or paper-based participating status grids. Paper-based participating status grids often contain old and inaccurate data and do not reflect the healthcare organization’s provider’s most accurate enrollment status. Cloud-based point of service enrollment validation tools are key to avoiding out of network patient payments, denials, and patient dissatisfaction.
A successful provider enrollment verification process begins with diligent upfront enrollment research. Having all the information in advance and ready before submitting provider applications makes a world of difference, including understanding what each health plan requires for a provider to be considered participating. Hospitals and health systems can either deploy automated cloud-based provider enrollment technology to manage this process themselves, or partner with an outside vendor that offers this technology.
Having a cloud-based software system in place enables schedulers to easily view provider enrollment status as cases are scheduled is essential. Typically credentialing and enrollment data is only accessible to back office staff. By providing front-office staff with the ability to access this data, schedulers can quickly view an up-to-date snapshot of provider’s enrollment status, including which health plans a provider is participating in. Having the right processes and technology in place significantly reduces, and often eliminates, provider enrollment issues.
As we move into the era of patient consumerism, these perceived “little things” will play a much bigger role in a patient’s selection process and overall satisfaction. An accurate provider enrollment process can be a competitive differentiator that helps a hospital stand out amongst its peers and competitors.
By Scott Friesen, CEO of Newport Credentialing Solutions