Hidden Ways Hospitals Can Save Money
Increased financial pressures are expected due to changes to the payer mix, the move towards value-based care and uncertainty over a new administration in Washington. For those who continue to operate business as usual, a sound financial future will be challenging, if not impossible, to achieve.
Traditional cost cutting measure like labor reductions and supply costs are no longer enough. Hospitals and health systems must look for new ways to reduce expenses and increase revenue. This requires out of the box thinking by looking at often overlooked areas, like credentialing and provider enrollment.
Navigating the credentialing lifecycle
When you consider that a health system or large hospital has easily hundreds of providers, the time spent managing credentialing and provider enrollment is significant. A practitioner enters the administrative maze upon completion of their residency, when they are about to become an attending physician. Once they apply for privileges at a hospital, the credentialing life cycle begins. The credentialing team can spend months managing the primary source verification (PSV) process and other credentialing steps as they work to verify a provider’s skills, training, education and licenses. Diligent follow-up is required along the way to ensure all verifications are complete and accurate. Next there is the provider enrollment process, which leverages essentially the same data gathered during the credentialing process, to secure a provider’s participation in health plans and achieve approval to bill the plan for services rendered. Then there is re-credentialing/appointment (required every two to three years), re-attestation (required every 120 days), and re-validation enrollment (required every five years for Medicare).
Read the article in Beckers Healthcare.
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