Best Practices Guide for Improving Provider Onboarding. A Checklist

Transcription

1 Best Practices Guide for Improving Provider Onboarding A Checklist

2 Provider Onboarding Provider onboarding is best described as the process of transitioning a prospective healthcare provider into a fully functioning and billable member of the clinical staff. In addition to orientation and training activities, onboarding includes a series of sequential administrative processes that, when completed, enables a provider to be fully utilized and payor reimbursable. These procedures typically consist of: Recruitment Employment Credentialing Privileging Payor Enrollment Leading healthcare organizations have recognized the substantial benefits stemming from improving their onboarding processes. These benefits include both improvements in financial performance and general provider relations. Consider a theoretical hospital system that employs 2,200 physicians with an annual turnover rate of 6% (132 providers). With average physician daily billings (revenue) at $5, and an onboarding process that averages 168 calendar days, the financial impact of reducing the onboarding cycle time by 20 days (14 billable days) would yield $8.8 million dollars (Figure 1.1) in additional annual revenue to the organization. This revenue flows directly to the bottom line. Best Practices Guide for Improving Provider Onboarding 1

3 Figure 1.1 Annual Revenue Increase Opportunity ( ) Average Physician Daily Billings Variance Between x Current and - Improved Onboarding Forfeited Billings Recovery Allowance (20%) x Annual New Physician Appointment ($ * 14 Billable Days) - $16, x 132 $83, $66, $8,807, Copyright SEERhealth 2012 All Rights Reserved. Many factors cause undue delays in establishing providers as productive and billable members of the workforce, including: Lack of enterprise-wide standards Decentralized quality assurance operations Siloed processes between organizations Lack of automation and information sharing Reliance on dated, paper-intensive processes Repetitive and redundant activities across facilities Ineffective reporting and managerial analytics These factors result in costly delays in the employment-to-enrollment cycle, unnecessarily heighten the burden on providers, and create animus between facility administration and clinical staff. Best Practices Guide for Improving Provider Onboarding 2

4 Leading healthcare organizations are addressing these inefficiencies by reengineering their quality assurance operations. In doing so, healthcare organizations are able to reduce the number of days to enrollment from days by days, resulting in millions of dollars in improved revenue and greater retention of top talent. SEERhealth has identified the following best practices for consideration by healthcare organizations throughout the recruitment to enrollment continuum. Please note that these practices may vary due to local regulatory or organizational by-law restrictions. Recruitment Initiate candidate relationships electronically. Use an electronic application to collect required candidate information and upload initial credentials documents needed for review by the medical staff Provide electronic access to candidate information for reviewers Require recruiters (both internal and external) to submit candidate information electronically Upon acceptance of a final offer, have new providers begin submitting their required credentialing information, privilege requests, and facility appointment application(s) Initiate required prime source verification activities as soon as practicable Employment/Credentialing Leverage everything collected and verified during the recruitment process. An initial credentialing packet could be % complete if information gathered and Best Practices Guide for Improving Provider Onboarding 3

5 verified during recruitment is utilized Automate the entire credentialing process. Eliminate cumbersome and dated paper-based processes Standardize credentialing requirements across all facilities to simplify multi-facility appointment For larger organizations, consolidate credentialing and verification activities within a quality assurance shared services center utilizing advanced technologies and production techniques to streamline the process Evaluate the outsourcing of some components of the process to qualified Credentials Verification Organizations Committee and Approval Automate the committee review process Utilize an entirely virtualized committee review process and require in-person meetings to review and discuss outliers (generally less than 5% of reviewed files) Have all documents and history, to include performance and risk management data, available to committee members electronically Privileging Automate the entire privileging process Utilize existing electronic libraries of standardized privilege definitions and modify them to meet organizational standards Use standardized privileges across the corporation -- allow for facility-specific Best Practices Guide for Improving Provider Onboarding 4

6 variances Tie all privileges to ICD/CPT codes Ensure all relevant departments across the enterprise have access to securely query privilege awards and standings Payor Enrollment Begin the enrollment process immediately upon awarding privileges Automate the enrollment process to the greatest extent possible using technologies that directly utilize data collected during credentialing and privileging activities Utilize technologies that leverage automated payor enrollment forms. Minimize the use of paper forms to the greatest extent possible Utilize all collected credentialing and privileging information Minimize risk of denials by creating customized, payor-specific workflows. Automate this process to the greatest extent possible Assess Your Organization SEERhealth has published a white paper with a comprehensive financial analysis of the impact of improved provider onboarding processes and has developed an Onboarding Financial Impact Calculator. To download the white paper entitled Recognizing the Benefits of Improved Provider Onboarding, or share it with executives within your organization, please click here. Best Practices Guide for Improving Provider Onboarding 5

7 About SEERhealth, LLC About SEERhealth, LLC SEERhealth develops solutions to modernize quality assurance within healthcare organizations. While our foremost objective with any client is to ensure the consistent delivery of high quality patient care, our solutions also seek to improve revenue, lower administrative costs, enhance risk management, maintain regulatory compliance and accelerate business improvement initiatives. Our proven approach has assisted some of the largest healthcare organizations in the United States to successfully transform their operations. For more information, visit our website at Contact SEERhealth, LLC 1600 Parkwood Circle, #600 Atlanta, GA Telephone: (770) Online: Subscribe to our Blog: Copyright 2012 SEERhealth LLC This document may not be duplicated, reproduced, cited, quoted or otherwise used without express written permission from authors. Best Practices Guide for Improving Provider Onboarding 6