Shortening the enrollment cycle

In the back office of every provider organization, far from the clinicians, there’s a team of people that keep the lights on. They don’t provide care, but they do provide the valuable service of managing the business of care. These teams in enrollment, billing, medical staff services, and revenue cycle departments perform a range of administrative tasks to ensure their organizations and clinicians get paid.

Though their tasks are often thankless, and unseen, these teams aren’t just a cog in a machine. The payer paperwork and tasks they perform—namely credentialing and enrollment—are more important now than ever. COVID-19 has heightened the need for finance and RCM teams to find ways to generate revenue. And at time when the dollars are desperately needed, there’s an opportunity to turn simple administrative tasks into profitable money-making tools.

The Status Quo: Manual Processes and Delayed Payments

Before newly onboarded clinicians can submit claims, they have to be enrolled and credentialed with their provider organization’s many payers. Additionally, existing clinicians have to be recredentialed with payers every few years. As a result, these tasks are often both a major barrier to revenue and a frequent hassle.

Current enrollment and credentialing processes involve multi-step, often manual and paper-based work performed by provider staff. The average provider works with about 25 payers. Any time a new physician joins the provider organization, staff have to chase down 25 sets of forms to get that physician enrolled and credentialed with payers, each with their own requirements and stipulations. Some reports suggest that the manual labor for these tasks adds up to anywhere from 8 to 30 minutes. And though online portals are largely the norm for form and provider data submission, a CAQH whitepaper found that 84% of attachments and supplemental information that payers require still travel by mail or fax.

In addition to being a time-consuming process, enrollments can take as long as 45 to 60 days for a full lifecycle. And credentialing can take even longer at 60 to 120 days. In other words, these processes are taking weeks or months. During the waiting period, claims cannot be processed, and funds are stuck in the revenue cycle. The impact is significant. For example, let’s say one physician sees 20 patients daily, generating $250 per visit and working 20 days each month. If that physician’s credentialing takes two months, that’s $200,000 the provider organization is missing in that time period.

Amidst COVID-19, when providers are facing decreased revenue, few can afford to have claims and payments delayed. Fortunately, there’s a relatively simple fix that can unlock revenue: shortening the enrollment cycle.

The Impactful Fix: Centralized, Digitized Processes

Though the bulk of the processing time of payer paperwork lies with the payer, there are steps that providers can take to shave time off of enrollment and credentialing turnaround times.

• Centralize provider data: One of the main culprits of form rejections, manual labor, and slow turnaround times in enrollment is a lack of provider data governance. Information tends to be scattered and out of date, requiring provider teams to track down the right information, or worse, have a form spit back from the payer to be redone. Provider teams needs one database of provider data that is kept up regularly so that enrollment teams can quickly and easily populate forms with the latest information.
• Build a payer form library: With 20-plus payers per organization, enrollment teams can spend unnecessary time keeping track of each payers’ forms, portals, and requirements. Additionally, payers can update their forms at a moment’s notice. Pulling new forms automatically would help providers cut down on the manual labor and time spent at the front end of the process. 
• Remove paper where possible: Though payers sometimes require paper to be shuffled around, often times enrollments teams just haven’t made the switch to more digitized processes. Providers looking to save time should evaluate their processes to find the steps that still include printing, signing, or mailing, and digitize those as much as they can. 

Though these steps seem simple, they do take time—and time is in short supply for providers, especially during COVID-19. This lack of time is precisely what makes enrollment teams’ efficiency so critical. The faster they can do their jobs the faster providers can add to the bottom line.

So, what to do next?

• Providers already working with RCM partners should gauge what solutions those partners have to shorten enrollment and credentialing cycles.
• Providers doing these operations internally should evaluate what buy-versus-build solutions they can quickly implement. The value is greater time and cost efficiencies internally, less manual and therefore disparate work, and best of all, getting paid faster.

Shortening the RCM lifecycle isn’t a nice to have, but a must do. Now, and always. The only question is who—internally or externally—will you partner with to get it done right?