How providers can increase revenue faster during COVID-19
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.
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.
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.
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?
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?