Today’s economic climate is having far-reaching, significant impacts on the healthcare industry. Sustained levels of inflation and rising operational costs threaten, at best, the profitability of healthcare provider organizations, and, at worst, their survivability. Increasing demand for non-acute services is exacerbating persistent workforce shortages, and policy uncertainty is brewing fears of reduced federal and state funding. With margins compressed to critical points, healthcare organizations are facing serious challenges with their operations.
The credentialing and enrollment processes, already wrought with opportunities for delay, are now challenged to move faster than ever before. With pressure mounting on supporting teams to onboard providers quickly, organizations must have credentialing and enrollment programs that collaborate coherently instead of compounding an already strained system. When this is accomplished, the organization has an effective provider onboarding strategy that allows for faster access to patients – supporting the demands of our healthcare industry and protecting vulnerable revenue streams.
Five credentialing automation best practices for large health systems
1. Establish an onboarding governance committee
The charter for this committee is simple: ensure the timely, compliant onboarding of new providers. The membership for this committee can vary depending on your organization but should include representatives from all functional areas involved in provider onboarding. The agenda is packed – what needs to be moved quickly once a Letter of Authorization (LOA) is signed? How are delays to onboarding being addressed? Align on start dates, status updates on medical staff credentialing, and enrollment status with your contracted payers. The committee should meet at least biweekly; this affords organizations transparency across critical operational units and an opportunity to address delays in onboarding.
Collaborate on process improvement goals, and, most critically, work together to manage start date expectations. Enrollment can take time and this can impact financials – account for this as early in the onboarding process as possible to mitigate financial loss.
2. Designate a provider onboarding team
There should be a single provider-facing team that engages directly with the provider, professionally represents your organization’s brand, and collaborates with the downstream administrative teams to ensure the timely exchange of documents needed to complete provider onboarding. In some instances, organizations are leveraging the practice leads or managed care team to expand their role to include onboarding functions. This team must have a baseline understanding of each component of onboarding, including risk management, as they will be the primary liaison between the provider and your organization during the initial phase of their employment.
This will eliminate delays, offer your providers a concierge-style onboarding experience, and help drive accountability across the organization.
3. Prepare a single onboarding packet
A critical outcome from the initial Onboarding Governance Committee meetings should be a single onboarding packet for each provider type. The onboarding team will be charged with ensuring that this packet is collected from the provider as quickly as possible upon an LOA or employment agreement.
Make a list of what each department needs from a provider, prepare a user friendly electronic application intake process, and ensure stakeholders can quickly access information and documents as needed for their purposes. For many organizations, this means centralizing all functions into a single technology platform. If your organization is still segmented across technology, this is still a feasible improvement opportunity – many organizations rely on secure file-sharing procedures. Be sure to lean on the experts of each department to determine what is needed in the packet.
4. Align start dates with critical milestones
Many organizations are reacting to start dates instead of proactively managing toward reasonable start dates. This is costing organizations hundreds of thousands of dollars in write-offs. Providers are reimbursable as of the effective date designated by the payer, and each payer is different. As a best practice, identify the plans in which to enroll providers and determine the average turnaround time for each. Leveraging existing utilization data, establish a priority list of your contracted payers with a special focus on those with higher timeframes and revenue streams. This should be reviewed during onboarding governance meetings to inform a provider’s start date. Sometimes urgency is out of our control, but, at a minimum, this will manage expectations and keep organizations ahead of financial impacts.
5. Let the experts lead the process
Protecting your organization from compliance and financial risk means working closely with your medical staff office and payer enrollment teams during the design and implementation of the onboarding process. They will ensure that procedures, such as the proper handling of credentialing and primary source information or enrollment data, comply with quality standards and payer requirements. Quality assurance reports and performance monitoring analyses should be done monthly to start, then quarterly. The Governance Committee should evaluate these findings and trend the data to ensure ongoing improvement of the broader onboarding program.
Regulations from accrediting agencies and payer requirements change, and organizations must be prepared to adjust or face costly delays and penalties. Ensuring that your experts guide the terms of the process will protect you from these risks.
With rising operational costs, labor shortages, and reimbursement challenges, healthcare organizations must find innovative ways to adapt to sustained economic compression. More and more organizations are investing in infrastructure, both technology and operational, to do just that. A current state evaluation of your organization’s onboarding strategy is a good starting point to identify opportunities for process enhancement.
