How do you gauge when your time or your staff’s time becomes more valuable spent on responsibilities other than applications, primary source verification (PSV), and enrollment? This is a dilemma that credentialing leaders at hospitals and managed care organizations face as their provider data management volume increases rapidly—but there are no plans to grow credentialing or payer enrollment staff size.
Physicians are learning how to become business leaders and tech experts in addition to maintaining full clinical schedules. They’re not alone in experiencing drastic changes to their roles in healthcare. The knowledge and skills required of those who perform provider data management will extend beyond PSV, credentialing/recredentialing, enrollment, and regulatory compliance to touch areas such as:
- Revenue cycle management
- Malpractice and risk management
- Project management
- Contracts management
- Quality management
A recent State of the Profession Report by the National Association Medical Staff Services backs this. In addition, hospitals and payer organizations struggle to hire and keep qualified credentialing and enrollment professionals, experiencing turnover that disrupts the business. In order to foster a credentialing workforce that’s ready to handle expanding core functions, outsourcing all or a part of credentialing and enrollment has become a successful business strategy.
CVOs can supplement—or fully supplant provider data management
Hospitals, commercial payers, and managed care organizations are realizing the return on investment offered by affiliating with an NCQA-certified credentialing verification organization (CVO) like symplr CVO. A full-service CVO is capable of offering services in primary source verification, credentialing, recredentialing, payer enrollment, and provider enrollment. Ask any credentialing and payer enrollment professional for their biggest pain point, and they’ll likely respond that it’s the time spent chasing data and conducting follow-up. The value of that time wasted is measurable, and it’s costly.
Most importantly, a CVO can be ready to support your needs large or small, long-term or temporarily, with a customized approach. Examples of the areas symplr CVO takes into consideration when working with partner organizations are budget, staff levels and roles, timelines, regulatory/accreditation obligations, and technologies already in use.
5 Provider management challenges met with the help of a CVO partner
An experienced CVO can help achieve organizational goals. Every healthcare setting comes with its own nuances, strengths, and areas ripe for improvement. Despite unique characteristics, symplr CVO customers on the hospital and payer sides have demonstrated that today’s healthcare landscape is forcing all participants in provider data management to sharpen their focus on some common pressure points.
- The need to demonstrate how safety and quality are baked into every step. Rightly so, healthcare is heavily regulated. In complying with state regulations, accreditation standards, or organizational policies, quality and safety must be measured and reported. A particularly bright spotlight shines on credentialing and enrollment as the front “gates” to patient safety. Partnering with a top-tier CVO in many ways serves as an insurance policy that supports your organization in making informed decisions about which practitioners have contact with patients or patient data, protecting all parties in the process. Quality standards exist for patient safety, of course, but also protect practitioners and your organization from negligent credentialing, Medicare fraud, and other detrimental outcomes. symplr CVO’s veteran team is well-versed in adhering to standards and regulations of The Joint Commission, CMS, DNV-GL, NCQA, URAC, and others, having been trained in an environment where safety is paramount.
- The need to onboard new healthcare practitioners faster—for revenue purposes. All payments in the life cycle of practitioner healthcare services flow from enrollment contracts. Payers commit to offering panels where members of their plan are satisfied with the choices of PCPs, specialists, and advanced practice professionals (APPs). Hospitals often operate on razor-thin margins, and hearing “no” from a payer that declines to enroll their practitioner can result in loss of revenue. Even enrollment delays of weeks or months cause revenue or quality problems. If there’s ever a place to partner with the experts, it’s at the enrollment stage with symplr CVO’s Payer Enrollment Services.
- The need to onboard new healthcare practitioners faster—to achieve customer service excellence. Our nationwide shortage of physicians is well documented and being felt more acutely as the population ages. As a result, most healthcare organizations, hospitals, and payers seek to attract and keep providers in a highly competitive environment. The faster recovery of revenue outlined above shouldn’t be the only goal of streamlining the credentialing and enrollment processes. File backlogs, separate enrollment forms that request duplicate data, and unfilled positions over time are symptoms of inefficiency. Practitioners are internal customers. Their satisfaction with onboarding, credentialing, and payer enrollment can foster commitment to your organization over the competition and in the long run. Delays also negatively affect patients’ access to care. On the other end of an extended timeline to onboard a provider is a patient waiting for access to a physician or APP. Primary source verification is frequently cited as a pain point for all parties involved. But employing the help of CVO credentialing experts can streamline and significantly shorten the time it takes.
- The need to make technology work for you, not the other way around. While many organizations have well-established account billing and clinical privileging processes, their payer enrollment procedures are inefficient or outdated. Further, most software used for credentialing and clinical privileging was not designed specifically to handle the enrollment of providers into private and government insurance payers. As a result, manual processes abound—even, surprisingly, at larger organizations. Some build workarounds or manual processes when their existing technology doesn’t meet changing needs. A full-service CVO can offer hospitals, practices, health plans and managed care organizations services and technology for contracting, credentialing/privileging, quality improvement, ongoing monitoring and compliance, and more.
- The need to benefit from one or more delegated relationships. For hospitals and payers, delegation is a successful partnership tactic that benefits hospitals and payers. Delegation is where a healthcare organization or health plan formally contracts to turn over some function(s)—typically primary source verification (PSV)—to another qualified organization. Most delegated relationships are for NCQA-certified organizations enrolling +150 providers, but every payer/health plan sets its own standards for what’s acceptable. Delegated credentialing can help your organization achieve faster effective dates, so providers begin billing sooner. Depending on the payer and the arrangement, following the receipt of a roster a new hire could potentially be considered as participating in a plan as early as the effective date they were approved by committee. Two outstanding benefits of partnering with symplr CVO are expert-level oversight of high volumes of data (individual practitioner data, contracts, and rosters); and ability to accommodate network growth and busy periods of credentialing or enrollment.
As your organization grows, and revenue and quality initiatives take a bigger bite out of your staff resources, consider partnering with symplr CVO. We can cover your entire payer enrollment credentialing or lifecycle—from onboarding to PSV and initial credentialing to recredentialing, payer enrollment, and ongoing monitoring.
