Overview

Last week, we reviewed the many components of the payer enrollment and credentialing process that must be differentiated and improved. Next, we’ll take a closer look at revenue cycle management and the opportunities to make your healthcare administration processes paper-free.

How Payer Enrollment Affects Revenue Cycle Management

The best revenue cycle management teams are highly skilled at looking for and avoiding blind spots. These teams monitor their financial data like a hawk and teach their clients and their teams how to spot inefficiencies and lost opportunities.

However, in order for a claim to be created and submitted for reimbursement, the provider must be successfully enrolled with an insurance payer and participating in their network. There is no revenue cycle management until the provider is legally able to see and treat patients. Each and every day that a provider is not able to bill for their services, revenue is lost not only for the individual provider, but for the organization.

In fact, one 2019 study by Merritt Hawkins showed that a provider generates $10,122 on average per day for their facility, so any delay or interruption is very costly. Furthermore, what they found is that if a facility could expedite their payer enrollment process by X days, substantial savings could be secured.

Savings by expediting Payer Enrollment:

  • Expedite by 3 days = $30,000 to $35,000 per provider
  • Expedite by 5 days = $50,000 to $58,000 per provider
  • Expedite by 7 days = $70,000 to $82,000 per provider

For example, if a healthcare group has 10 physicians waiting 7 days each to start billing, that’s 70 days gone.

  • 70 days x $82,000 = $5.74 Million in lost revenue per week

These figures are absolutely staggering. Clearly the financial impact of delays in the provider onboarding process is significant, both from a scaling perspective and from a revenue cycle management perspective as well.

Understanding Payer Timelines

As one can see, delays in payer enrollment and credentialing is an expensive problem that healthcare providers cannot afford to make when they are already facing staffing wage increases, higher inflation rates, and denials on the rise.

The reality is that getting to participation status takes time, and payers cannot be rushed. A typical provider contracts with 20-25 payers annually, so think about the total amount of time this entire process takes per provider. While there are many steps that can be taken to streamline the payer enrollment process, payers have their own lengthy process that must be completed before they can accurately credential those providers.

Be aware of these key points to realistically align expectations:

  • Insurance payers have their own timeline and workflow they follow
  • Once the payer application has been submitted, it’s out of your control
  • Complaining to the payer does not help speed up the process
  • Some healthcare organizations have reported not receiving an effective date after their providers were enrolled

There are some instances where a provider can bill retroactively for their services before they are fully credentialed and enrolled, but it is important to find out which payers allow this and which do not. Do not assume it is allowed.

Below are the typical timelines for provider administrative teams to complete each of the following payer enrollment tasks.

Typical Provider Administrative Timelines:

  • State Licensing: 3-6 months
  • Credentialing: 4-6 months
  • Payer Enrollment: 4-6 months
  • EDI Enrollment: 3-5 months
  • CME management: continuous
  • Management of Directories: continuous

These are all painful tasks that have to be done continuously. If an individual handling these tasks makes an error in state licensing for example, their timeline could now jump to 9 months or longer. Furthermore, if a payer removes a provider from a panel for an expired medical license and a recredentialing request is not submitted in time, the appeal process can take 1-2 months – more revenue lost on mismanaged provider data.

The 5 Biggest Pain Points of Payer Enrollment

When thinking of all the precious hours that an administrative team pours into the complex process that is payer enrollment, it can feel overwhelming. Here are some of the biggest pain points that healthcare organizations have with payer enrollment:

  • Slow Manual Process: Inheriting a credentialing process that is based on manual spreadsheets and has little to no way of easily tracking what tasks have been completed or followed up on
  • Lack of Clarity: Little to no documentation of workflow or enrollment status when replacing and training new staff
  • Unable to Scale: Finding qualified staff has never been this challenging with the Great Reshuffle; hiring more employees is no longer affordable or scalable
  • Resource Intensive: Spending days tracking down the payer application and requirements, tediously reading the fine print for each payer’s unique requirements, and then manually faxing or FedEx’ing stacks of paper- all while hoping there weren’t any errors on the forms
  • Error-Prone: About 20% of enrollments are rejected due to errors, so medical staff start the whole process of finding, completing, and submitting forms again, and the admin team only becomes aware of them after spending hours on the phone asking payers where their reimbursements are

Healthcare executives must reflect on their organization’s payer enrollment process to identify any potential gaps that can be closed. Look to see if your organization’s current processes are as efficient and effective as possible. Ask yourself if your current provider enrollment and credentialing processes are meeting your organization’s goals, KPIs, quality metrics, and consequently enhancing the bottom line? Be honest with yourself. Executives often do not realize how much their provider onboarding process is bleeding money.

5 Strategies to Improve Your Payer Enrollment

While it is important to recognize the challenges of the typical payer enrollment process, there is hope that credentialing and provider onboarding can become much easier to manage with the right tools and processes in place. Here are 5 strategies to improve your payer enrollment process:

  1. Get quality data the first time:** To get better outputs, one must focus on improving the quality of their inputs. Many credentialing managers’ biggest pain point is the back-and-forth requests to their providers to get ALL of their intake information the first time. With customized intake forms sent with the click of a button, admins can select which fields are required before submitting provider data into their management portal. Better inputs means quality outputs. Save the hassle and only do the work once.
  1. Organize your data:** One cannot stress the importance of organizing provider data into an easy-to-view dashboard with simple categories showing pending enrollments, professional licenses with a countdown to expiration, which tasks are ready to be worked in a user queue, and CAQH integration. Organization means less errors, resulting in fewer delays to start billing.
  1. Use pre-populated forms:** There’s a reason that TurboTax continues to be one of the most popular platforms on the market – because it auto-fills fields so that a human doesn’t have to. Taking it a step further, it even provides step-by-step instructions and outlines the requirements needed to submit tax forms correctly. By mirroring this idea with payer enrollment, healthcare organizations can take advantage of using pre-populated forms with provider data imported directly into the application forms, as well as step-by-step instructions extracted straight from the payer’s website.
  1. Follow up persistently:** With customizable follow-up reminders and quick reference to provider data at your fingertips, it’s possible to have a platform that is easy for your team to view which payers need a follow up, and how many days it’s been since your last outreach. In the case of provider enrollment status updates, polite persistence always pays off.
  1. Know when to reach for automation tools: Many healthcare organizations attempt to keep their PE and credentialing functions in-house, oftentimes thinking that it will save them money. The truth is that the workload of a medical staff professional tasked with credentialing and provider onboarding is often too much for only one person to feasibly handle. More and more organizations are turning to automation tools to simplify administrative tasks to reduce employee burnout and reduce the need to hire additional MSPs.

When thinking about the impact of poor data management, one must recognize how critical good data is, and conversely the impact of inconsistent data on administrative tasks. Provider data supports everything from onboarding providers successfully, maintaining a healthcare organization, and its ability to scale. These improvements directly impact the quality of care in the US— which means less money spent on healthcare administration, and more money spent on patients.

** Madaket’s SaaS platform features these improvements

Learn How Madaket Can Improve Your Payer Enrollment Process

Here at Madaket, we want you to achieve greater value in both your time and your money by utilizing our Provider Data Management platform to automate your administrative tasks so you can focus on providing quality care to your patients.

With one easy portal, your team can quickly view all aspects of provider data management including: easy enrollment with payers or approve providers, track expiring licenses & credentials, send/receive payments at light-speed, reduce administrative waste, and increase data accuracy through continuous data coordination. It’s that simple.

Our clients have enjoyed several advantages of implementing Madaket’s Provider Data Management platform to manage their provider data, such as:

Improvements in:

  1. Getting clinicians practicing and billing sooner
  2. Improved departmental communication
  3. Speedier enrollments
  4. Faster reimbursements
  5. Quicker network expansion
  6. Quality & integrity of provider data

Reductions in:

  1. Participation timelines
  2. Hiring additional staff
  3. Duplication of work
  4. Lost revenue
  5. Errors
  6. Write-offs and claim holds

Contact Madaket now to learn how your organization can see immediate benefits while laying the groundwork for paper-free healthcare administration in the future. info@madakethealth.com