Healthcare M&A Activity in the Wake of COVID-19: Provider Data Management is EssentialThe COVID-19 pandemic has created the greatest financial crisis in history for healthcare organizations.
How Healthcare Organizations Can Help New Providers Navigate the Credentialing Process
The COVID-19 pandemic has created the greatest financial crisis in history for healthcare organizations.
A report from the American Hospital Association (AHA) estimates a total impact of $202.6 billion resulting from COVID-19 expenses and lost revenue for America’s hospitals and health systems over the 4-month period from March 1, 2020, to June 30, 2020.1 These COVID-19-related losses may accelerate healthcare mergers and acquisitions (M&As) in the latter half of 2020 and into 2021.
When you merge or acquire a healthcare organization, you aren’t just taking on new (to you) buildings and staff. You are also acquiring significant amounts of data, including contract and provider data—such as demographic information, credentials, health plan participation, and performance and quality data. You need this information for credentialing, privileging, enrollment, payer contracting, and maintaining accurate payer provider directories. Therefore, you must focus on provider contracting and data management in your post-M&A integration plans.
Critical provider data is often stored in physical and virtual silos—different buildings and software systems—that make it difficult, if not impossible, for different departments to access the data. The first step after an M&A is to review and consolidate this information into one centralized provider data management system:
Provider Data. When this information is stored in multiple locations, accessibility and transmission can require a significant lift from both administrative and technological perspectives. Furthermore, it is challenging to ascertain whether provider data is current and correct. You need accurate data for provider credentialing, privileging, enrollment, and maintaining participating/non-participating (PAR/NON-PAR) status. Inaccurate data can cause delays that lead to postponed reimbursement and unhappy providers. You must be able to provide up-to-date provider information to payers to avoid sending red flags to CMS.
Contract Data. Through an M&A you inherit multiple provider contracts, including fee schedules and rates with different insurance companies. When provider and payer contracts are stored in separate contract management systems, those contracts are difficult to locate and convert correctly. From a managed-care perspective, the acquiring institution’s contracts include any new specialties, taxonomies, and other additional payer-specific requirements necessary to avoid claim issues.
Tax Identification Numbers (TINs). Healthcare organizations have different TINs. The acquired organization’s TINs may be converted into the acquiring organization’s TIN. Should the acquired organization’s TIN remain in place for any period of time, the TIN must be added to the acquiring organization’s payer contracts. If that doesn’t happen, payments may be stopped or routed to the wrong TIN, resulting in delays in posting that can create cash flow problems.
How can you manage and consolidate your post-M&A provider data?
The right provider management software eliminates data silos and facilitates data consolidation, access, and ongoing management. If multiple systems are being used, your first step is to choose a single provider data management solution. Evaluate the current software:
- Can it manage and report out on the entire provider onboarding process—including credentialing, privileging, enrollment, and ongoing provider data management?
- Is there an option to import and automate data standardization rather than manual completion, which could result in compromised data?
- Is provider data stored in one centralized database that can be easily accessed by people in different departments at multiple locations? Each department should be able to track a provider’s progress through the onboarding and re-credentialing/re-enrollment processes.
- Can any current manual processes be made easier by the solution? Are there built-in efficiencies and workflows for PSVs, peer references, and decision-making that easily conform to the new bylaws and requirements?
- Is each provider’s data linked to all of their enrollment contracts? Updating payer directories and re-enrolling providers is simpler when you have this connection.
- Are any of the new or existing payer contracts delegated? If not, is there an opportunity to convert a non-delegated payer contract? Updates submitted via delegation can be sent en masse, are processed with a faster turnaround from the payers, and can be easily tracked in a centralized system.
After you’ve chosen the best provider management solution, you must convert and validate all your provider data to the new system. For hospital settings, decisions must be made with respect to the credentialing and appointment of the incoming providers. Managed care must ensure contracts are reviewed and updated in a timely manner.
The next step is to evaluate your in-house resources. Do you have enough highly skilled staff to handle the number of providers being onboarded? Can your staff quickly consolidate TINs so reimbursement is not delayed? If not, consider outsourcing provider onboarding and TIN consolidation to a partner with proven experience in provider credentialing and enrollment post-M&A integration.
Healthcare M&A activity is likely to increase in the coming months, as healthcare organizations continue to feel the financial impact of the COVID-19 pandemic. By quickly consolidating provider and contract data, you can minimize the financial and compliance risks to your revenue cycle, resulting in continued provider and patient satisfaction.
TractManager’s Provider Management solutions use cloud-based technology to centralize and integrate provider data and seamlessly manage the entire provider onboarding process and ongoing provider data management. TractManager’s experts can quickly and accurately handle your TIN conversions/consolidations, keeping track of changes and making sure all information is up to date so you experience fewer claim denials. TractManager’s provider experts worked with Penn Medicine’s many payers to quickly consolidate their TINs from 32 to one. Read the Case Study.
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