Many hospitals and other organizations see credentialing and privileging as necessary costs of doing business. They may be surprised to find that these business processes can actually become a strategic profit center that lowers costs and boosts revenues. The key is streamlining these processes so new practitioners can become full, revenue-producing members of the organization faster.
“Healthcare organizations can see substantial returns from investing in improvements to better align or integrate their credentialing and enrollment processes,” wrote Amy Niehaus, senior consultant for the Greeley Company, a national healthcare consulting and professional services firm based in the greater Boston area, in a recent article in Becker’s Hospital Review, Reclaiming revenue: A found- money trifecta in credentialing, privileging and enrollment.
A more time-consuming process than some think?
In order for providers to see patients and bill for services, they must be credentialed, privileged and enrolled. Credentialing involves validating the practitioner’s credentials and experience. Accreditation organizations such as the Joint Commission require medical staff service professionals to verify this data with primary sources such as education and training institutions, hospital affiliations, and licensing agencies. Once application materials are verified, medical staff leaders determine what clinical services the physician is qualified to provide, known as privileging. This process is also replicated during insurance network enrollment.
These processes are often redundant and rely on inefficient, paper-based communication that can cause considerable delays in onboarding new providers. The Becker’s Hospital Review article noted that turnaround for a single practitioner—from receipt of the initial application to final approval—averages 50 to 90 days.
It’s possible to make the argument, however, that medical staff services departments (MSSDs) should consider evaluating turnaround time not from the time an initial application is received, but from the time the initial application is sent. In a SkillSurvey study from 2016, the initial medical staff application was found to be the single biggest source of delay in the credentialing process. A more recent SkillSurvey study found that it takes 3-4 weeks to receive an initial application. This means it may take an additional 30 days before the credentialing process can even begin, offering a turnaround time closer to 80 to 120 days. Taking a bigger-picture view can provide a more realistic portrait of how long it takes to privilege a single practitioner.
Insurers may take an additional 60 to 120 days to enroll the provider.
Overall, the end-to-end process can conceivably take up to eight months to complete, while 84% of survey respondents said that the process of privileging a single provider takes 5-6 weeks.
Time is money
Long turnaround times for practitioner credentialing and enrollment have considerable financial impact on hospitals. Employed practitioners in the process of being credentialed are paid their salary, even if they’re unable to see patients and bill for services. This means they’re an expense to the organization.
Hospitals suffer from opportunity costs because practitioners who are unable to see patients cannot bring in revenue. For example, the cost of one week’s delay in credentialing for the average primary care physician can amount to nearly $30,000 due to an inability to bill.
Furthermore, delays in payer enrollments disrupt cash flows. While practitioners who are credentialed and privileged, but not enrolled, can see patients, they cannot receive payment for claims until they’re enrolled with the appropriate payers.
Cloud-based credentialing solutions, such as SkillSurvey Credential OnDemand®, deliver high-quality efficient workflows that streamline and accelerate the entire process and get physicians generating revenue faster. The solution improves the credentialing process in the following areas:
- Real-time process management: Because the system provides real-time data, the medical staff specialist can begin credentialing tasks and verifications from their online dashboard as an applicant enters their information, even before the application is complete and submitted. The technology automates critical tasks like sending requests and reminders and evaluating information for red flags so applicant files come together more quickly and references don’t have a chance to forget to return a questionnaire.
- Initial and re-appointment applications: An engaging online user interface and guided prompts make the application process logical, simple and easy to complete. The applicant is walked through the application section by section, which continuously displays the percentage of completion. If the application requires the same information in multiple sections, the applicant inputs it once and the system autofills the other sections. The system automatically tracks completed and uncompleted tasks and uses customized rules to flag potential issues for review.
- Peer references and affiliation verification: Mobile-enabled peer referencing allows practitioners to provide immediate peer reference feedback from smartphones, tablets or computers 24×7. The peer reference request is kicked off when the applicant enters the information about their peer references (or by the MSSD, if preferred) so the process starts as soon as possible. Peer references can even submit their responses before the applicant completes and submits the final application. Time to receive peer references shrinks from weeks or months to three days.
- Credentials review: Department chairs and review committees have access to a secure online dashboard that lets them conveniently review files and make privileging recommendations on the go. Reviewers can use any device to find real-time data on applicants in-review including red flags, notes and previous committee decisions.
With an automated cloud-based credentialing solution, such as SkillSurvey Credential OnDemand, healthcare organizations can significantly reduce the time it takes to credential and privilege providers. New practitioners start seeing patients faster so they more quickly move from being a cost center to a revenue generator…. and significantly improve hospital ROI.
For more information, please download our white paper: Cloud-based Credentialing: Next-Gen Solution for Today’s Healthcare Industry Challenges.