6 Benefits of One Source of Truth for Provider Data for Credentialing and Enrollment and How to Get There
Enrolling providers in health plans is a high-stakes function, especially forhospitals that are experiencing an increase in employed providers.
A recent VerityStream survey indicated 48 percent of Medical ServicesProfessionals (MSPs) report that increasing numbers of employed physicianswere having an extremely or very significant impact on their organization.The rapid increase in employed physicians and growing complexity aroundcredentialing and enrollment requirements, continues to lengthen the time ittakes to get providers to work.
With the average new provider generating $6,641 a day in revenue, every dayenrollment is delayed costs money—lots of money. In fact, our research indicatesthat on average, hospitals typically lose $150,000 to $250,000 per providerduring each of the first three years of their employment.
If you're a MSP responsible for credentialing and/or enrollment, you may befeeling frustrated. We get that. Fortunately, our team at VerityStream is in a uniqueposition to offer advice. Our experience helping more than 2,400 hospitals and1,000 medical groups with credentialing, privileging, enrollment, and evaluation,has taught us a few tips and tricks for speeding these processes up. One of themis: data consolidation.
Data Consolidation Defined
When the relevant data required for credentialing and enrollment resides inmultiple databases across different facilities—you're sure to have issues with dataredundancy and data inaccuracy. This will lead to a host of problems includingcompliance issues and poor provider satisfaction to site just a few.
Data consolidation creates a single source of truth for provider data, with oneapplication and one reappointment date across all system facilities. A physicianis in the system only once for all credentialing and re-credentialing purposes,removing the need for multiple spreadsheets and checklists. A single platformalso offers workflow management and promotes proactivity, generating remindersabout TJC, NCQA, CAQH, directory updates, and more.
Six benefits of data consolidation
1. Improve data accuracy
Redundant and manual processes acrossfacilities make it virtually impossible to collectaccurate data in a timely fashion. A singlerepository for provider data enables you tocreate an accurate dataset that can be sharedacross your organization. The ability to manageand audit data electronically, eliminates paperand rooms of wall-to-wall file cabinets whilefreeing up staff time to focus on data integrity.
2. Increased compliance
Health plan provider directories get their data directly from health systems. InJanuary 2017, a CMS audit of Medicare Advantage online directories audited 54parent organizations and issued 52 compliance actions. The report found that45.1% of provider locations were inaccurate. Consolidation addresses this risk byestablishing a centralized repository for collecting, storing and communicating themost up to date, accurate information on locations, phone numbers, specialties,and more.
3. The ability to take advantage of delegated credentialing
The holy grail in enrollment is delegation. Delegation means the payer hasdelegated the credentialing process to the healthcare system and agrees toaccept their paperwork. The payer also agrees to accept the credentialingcommittee's decision date as the provider's start date, often times cutting weeksout of the provider enrollment process. Without delegated credentialing, thehealth plan determines the effective start date, placing provider revenue at risk.Delegation gives your health system greater control over time-to-revenue.
4. Streamlined reporting
A single data set facilitates system-wide reporting that also integrates with yourEMR. Instead of dedicating resources to cobbling together reporting, the staff canconcentrate on trouble shooting issues and improving processes.
5. Enhanced provider satisfaction
Providers want to focus on the providing care to their patients—not providingredundant data. A fragmented approach to collecting the data required forcredentialing and enrollment is sure to drive down provider satisfaction. A singlepoint of entry where all stakeholders, including providers, chairs, and chiefs cango 24/7/365 to input and access the information they need greatly improvesthe provider experience and reduces onboarding timeframes. While it's difficultto monetize provider satisfaction, declining engagement surely correlates withdeclining revenue.
6. New levels of collaboration
Redundant work processes also frustrate the credentialing and enrollment staff.Sharing provider data across your organization requires collaboration amongdiverse groups who may not have typically worked in close concert before: aproject manager and other representatives from credentialing, IT, and hospitaladministration. A new collaborative process results in teams who questionprocesses and how they operate. While consolidation can create trepidation aboutjob security or loss of control, it's important to note that the process improvementsit yields often enhance job satisfaction. Credentialing and enrollment haveevolved, and best practices have emerged that save time by eliminatingcumbersome steps from everyday workflows.