Provider Onboarding Starts with a Contract

Provider onboarding often takes 90 to 180 days. When the process takes so long, healthcare organizations lose revenue.

Faster provider contracting speeds up onboarding and delivers revenue. The faster the healthcare organization navigates contracting, credentialing, privileging, and enrollment processes, the sooner providers can begin seeing patients and getting reimbursed.

Provider onboarding starts with the provider’s contract. Unfortunately, so do the delays. Every provider agreement includes a variety of terms detailing highly regulated aspects of the relationship such as compensation, bonuses, and tuition reimbursement. Complicating matters is the fact that some providers negotiate their own contracts. With manual provider data management processes, getting a provider contract through review and approval is often cumbersome and time-consuming. When paper contracts are manually negotiated, executed, stored, and managed in disparate locations throughout an organization, contracting and the rest of the onboarding processes are delayed. Additionally, manual contracting has a significant impact on administrative burden as well as physician engagement and happiness.

How can you improve and speed up provider contracting?

  1. Start with clean, accurate provider data. Current, correct information is essential for every step in the onboarding journey, so it’s important to follow industry standards and best practices when entering and sharing provider data. Maintaining provider data accuracy is essential to comply with federal, state, and payer regulations. The Centers for Medicare & Medicaid Services’ (CMS) review of the provider directories for 52 Medicare Advantage organizations (with a total of 5,602 providers reviewed at 10,504 locations) revealed that almost 50 percent of the directory locations listed had at least one inaccuracy. In response to the review, CMS issued 18 notices of non-compliance, 15 warning letters, and seven warning letters with a request for a business plan.

CA SB 137 requires that health plans maintain an accurate provider directory and update their directories weekly. Health plans reach out to healthcare organizations every six months to validate the accuracy of provider information. A healthcare organization’s failure to respond to these health plan inquiries can result in severe penalties: removal from the provider directory, delay of payment or reimbursement, or even termination of the provider contract.

  1. Centralize your provider contracts. Eliminate paper documentation and one-off locations for storing provider data by storing your digital provider contracts in one central, searchable database. This makes contracts quicker and easier to locate and manage, and easily accessible to all relevant staff, across departments, increasing transparency throughout the healthcare organization. When provider data is stored in a single location, it creates administrative efficiency and eliminates duplicate entry. Identify and avoid potential compliance risks. Three main laws—the Stark Law, the Federal Anti-Kickback Statute, and Internal Revenue Service guidelines related to tax-exempt status—impact compensation-related employment arrangements between providers and hospitals. To comply with these laws, provider compensation must be consistent with fair market value and not take into consideration the value or volume of referrals the provider brings to the healthcare organization. Contract analytics identify key terms and clauses in your contracts to help you manage provider relationships and compensation and avoid expensive penalties for compliance violations.
  1. Use contracting software that is integrated with credentialing. When provider contracting, credentialing, privileging, enrollment, and compliance activities are conducted manually by several departments that don’t communicate with one another, provider onboarding takes significantly longer, and the delays are costly. Start receiving reimbursements for services rendered in a more timely manner by combining provider contracting and provider onboarding.

This integration effectively digitizes provider contracts and monitors critical dates, terms, and notifications. It automates downstream triggers such as initiating credentialing, finalizing contracting, terminating contracts, and submitting timely provider notifications. Because data is validated at the source, changes in provider credentialing can be fed back into contract management workflows and reports, allowing real-time review and corrections. This integration speeds up the entire provider contracting and onboarding process, so providers can start seeing patients and getting reimbursed sooner.

TractManager’s Provider Management solution accelerates provider contracting and onboarding by integrating MediTract CLM with CARE, our cloud-based credentialing, privileging, and enrollment software. With this integration, you’ll generate reimbursements for services even faster.

Author:

Kimberly Hartsfield

Chief Data Officer

Kimberly Hartsfield became Chief Data Officer for TractManager in June 2017.

 

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