There’s no time to waste when providers are unable to generate revenue until they are enrolled with payers. Unfortunately, insurance payers have their own timeline and workflows. And while you can’t control their process, you can control yours. Provider enrollment metrics will help.
Using your organization’s own data, you can better understand what is happening in your provider enrollment process and make changes to speed things up.
The Impact of Payer Enrollment on Organizational Revenue
Healthcare executives get pretty worked up over provider enrollment delays and there’s a good reason. Providers cannot submit a claim for reimbursement of services unless they are successfully enrolled with a payer and participating in their network.
According to Merritt Hawkins, providers generate just over $10,000 per day for their facility. Which means just a few days can make a dramatic impact on organizational revenue.
Enrolling a provider 5 days faster = $50,000 in increased revenue per provider
Enrolling a group of 3 providers 5 days faster = $150,000 in increased revenue
Clearly, if it was easy to shave a few days off the enrollment process, everyone would be doing it. Every payer has their own unique set of requirements to enroll a provider; from wet signatures to portals and state-specific forms, the hoops you have to jump through are endless. Which is why leading healthcare organizations are relying on data to provide insight.
5 Key Provider Enrollment Metrics to Watch
When you’re managing a process as critical to your healthcare organization as payer enrollments, you need to be able to make data-driven decisions. Why is the process taking so long? Is there a better way to do something? Are we meeting organizational goals?
These are the five key prover enrollment metrics that will help you answer those questions and more.
1. Number of Unassigned Applications
Keeping track of the staff member who is working on every application will give you plenty of insight into your process. You’ll know at a glance if one credentialer is overloaded, or if another can take on more work. Plus, you’ll be able to catch unassigned applications before they become a problem. In many organizations, it could take months before someone realizes an application wasn’t assigned to a credentialer, which likely means no progress has been made.
2. Average Duration of Open Applications
Open enrollment applications are dollar signs adding up every day a provider is unable to bill for services. When you’re keeping a close eye on these numbers, you can be proactive and work to close them more quickly, or at least have an explanation ready when you’re called into the boss’ office. The average length of time that applications are open varies from organization to organization, so it is important to know yours. It’s a great benchmark and will help you to identify trends in locations, specialties, and payers.
3. Total Applications Closed by Employee
Enrollment age tells you how long it is taking each credentialer to process an application. Don’t immediately jump to a “gotcha” scenario! When you see a credentialer outperforming their peers, it’s an opportunity to find out what the person is doing and replicate their process across the team. For example, an outperformer probably has process checklists set up for every single application to keep everything organized and on track. By using a standard process with reminders set up, it is much easier to reduce downtime and delays.
4. Length of Application Process by Payer
There’s very little — if anything — you can do to change or accelerate the payer’s enrollment process. Once you’ve submitted your application, you’re at their mercy — which is why everything really needs to be correct the first time. What can help you, though, is to know which payers are taking the longest to complete their applications and which payers are the quickest. With this information, you can better manage internal expectations for how long the process will take and you can also plan accordingly when you know payer recredentialing is coming up.
5. Length of Application Process by Provider
Sometimes (maybe a lot of the time), it’s not the credentialer’s fault that a payer application has been lingering. Physicians are very busy and may be unresponsive to requests the credentialer is making. That’s why it is so important to know which applications have the longest time to complete submission. If there are multiple for the same provider, that provider could be the problem. Or maybe it’s a trend for an entire department or location. Armed with this information, you can bring in the chief medical officer or even the chief executive officer to give a friendly nudge.
Getting the Provider Enrollment Data You Need
If you primarily work in spreadsheets and pivot tables, you’re probably wondering how you would possibly have the time to collect all the information — and keep it updated. That’s a fair assessment.
This kind of access to real-time provider enrollment metrics is one of the main benefits of credentialing software. The best platforms include this information in dashboards so it is easily accessible anytime — such as when the CFO or quality improvement team wants to know why claims are getting denied.
Imagine having these enrollment application insights at the click of a button. You could make small improvements that dramatically speed up your process. You’d gain the trust and confidence of providers and your CEO, who is seeing dollar signs every day providers are enrolled.