These days, we can track anything—our productive hours, our sleep, our daily steps. Enrollment processes between providers and payers shouldn’t be any different, particularly as teams disperse and remote work becomes the norm. Now is the time for clearinghouses and other RCM partners to examine their enrollment programs and ensure they are doing their best to help payers and providers through our shifting work environment. By assessing key metrics and zeroing in on areas for improvement, clearinghouses and RCM partners can step up their administrative processes and prove themselves more valuable to their customers, now and in the future.
Turnaround time
This goes without saying—turnaround time should always trend downward. Even on a good, pre-COVID day, enrollment transactions took weeks and months to complete. The average EDI enrollment process, from start to finish, can take six to eight weeks—a massive delay for providers waiting on payments for the ongoing care they’re delivering.
Why does it take so long? Usually, due to manual labor. We’ve got about 4,000 payers here in the U.S., each with their own forms, standards, requirements, and portals used to transact with providers. Whether done by the provider themselves or clearinghouses and vendors, there’s a lot of downloading forms, tracking down provider information, retyping that same information into different forms, faxing—yes, still—emailing, uploading, and calling for status checks on forms that have gone into black holes.
The key to reducing turnaround time is automation—automating the data collection from providers, automating the form collection from payers, automating the data population, automating the provider data management—automating the whole process. With 65% of provider groups on our platform, Madaket can easily use and reuse data, pre-populate forms, and compress turnaround times significantly. We’ve helped clearinghouses go from 56 days to 17 days and 32 days to just 4.5 days in turnaround times, simply by introducing automation.
Rejection rate
Speed is not the only important metric; accuracy is equally as important. Once forms go off to payers, there’s no guarantee the data are in the exact right format payers require. And if one data point is off, the whole form is rejected, and the process starts over. In our work with PNC Healthcare, we were able to help the clearinghouse get its rejection rates down from 20%—the unfortunate industry-standard rate—to just 5%.
Pending dollars
Slower turnaround and follow-ups, and high rejection rates, all boil down to time. And, as we know time is money. How much? Let’s do some simple math.
The average primary care physician sees 20 patients per day. Let’s say, on average, they receive $250 per visit from one of their payers. And, let’s assume they work about 20 days in a month. If that provider’s enrollment processes require more than 30 days, that’s $100,000 worth of payments held back from the provider organization. Now, if that provider organization is enrolling a handful of physicians each month—provider consolidation is expected to tick up due to the pandemic—that can add up to a few hundred thousand dollars.
If you’re a clearinghouse and can shorten that window of lost time and lost dollars for your clients, you’re golden.
Client satisfaction
Speaking of clients, how happy are they with you? Are your provider organizations satisfied with how you do things? Or are they tired of sending spreadsheets back and forth? Do you issue an annual survey to ask? Or are you too afraid to ask because you already know the answer?
The ultimate goal in improving these metrics is to keep both your providers and payers happy. The more you can effortlessly shuffle “papers” between the two, the more time and resources they have to spend on their own metrics—the clinical ones.
Whether you’re looking at EDI enrollment or payer enrollment, the old Peter Drucker adage applies: “You can’t manage what you don’t measure.” Take a look at your metrics and see how you can propel your organization forward.
With 65% of provider groups passing through our platform, we can help you evaluate and benchmark your metrics. Get an EDI Enrollment Diagnostic Report to discover easy ways your organization can improve.
