Our client is a large physician group that was experiencing major delays in credentialing and enrolling their providers with hospitals and payers. As one of the largest private Otolaryngology group practices in Southeastern Florida, with 38 office locations that each has hundreds of practitioners on staff, the delays were a significant monthly cost in lost revenue. They turned to Acorn for a solution to improve efficiency and enable faster enrollment.
Typical Credentialing and Enrollment Process
The provider, the enrollment/credentialing department, and the leadership of an organization are all involved in this process. It starts with the provider applying to various hospitals for hospital affiliation and clinical privileges, and to payers for payer enrollment and contract. The Medical Staff/Payer Enrollment Team then goes through the laborious process of primary source verification of the provider’s education, affiliations, licenses, boards, references and other sources to compile a database of the provider’s training and experience.
The industry’s average processing time for this is 120 days, with 90 days as a gold standard. Following the compilation of this data, the enrollment team fills out paper applications for each provider coming on board, as well as re-enrollment applications for the providers on staff. The importance of this process cannot be understated. Misinterpretation of data, data errors, and omissions result in negligent credentialing. Negligence brings significant risk to an organization and can result in millions in lost revenue, increased liability, and expensive court cases.
It is important to increase the efficiency of the process without impacting the quality of the work. The right solution to manage enrollment processes can make or break a healthcare organization.
Our client was using a software that did not suit their workflow, business needs, or staffing demands. While it improved the efficiency of some processes, many tasks were still done on paper or spreadsheets.
Every payer that a provider enrolls with requires similar information from the provider. But every payer organization has its own application format, resulting in repetitive data entry to complete different payer applications. Each provider is enrolled with at least 10-15 payers. Completing these applications manually was causing dissatisfaction among the providers because the process took too long.
Providers’ expirable tracking, CME tracking, setting up expiration and renewal alerts on personal calendars, sending reports to upper management—these tasks were time consuming and required full-time personnel to complete.
The entire process involved the submission and tracking of applications, repetitive data entry, and expirable tracking. It made the process tedious and labor-intensive, which cost valuable time. Ultimately, it led to delays in patient care and severe losses in revenue for the organization.
Our client adopted the Acorn Solution for Providers and Practice Groups and instantly improved the productivity of the Enrollment Office. The platform’s easy-to-use interface and automation significantly decreased the turnaround time of enrollment applications, which enabled providers to begin billing in less time.
Acorn’s application management section increased the satisfaction of the Enrollment Staff, which led to a high adoption rate of the new solution. The expirable/renewal alerts and reports remove busywork, making things simpler and saving time. The interactive dashboard helps the staff plan the workload 90 days in advance, making them proactive and more effective.
In comparison to the client’s old system and its paper processes, Acorn increased efficiency by 83% in the first few months.
The new software and automation in comparison to the paper processes increased efficiency by 83% in the first few months.
Benefit: Provider Satisfaction
Provider satisfaction has increased significantly with Acorn. The platform offers each provider an accessible portal—the Medical Passport—which is a central repository for data and documents and gives control of the information to the provider. The ability to populate their data from a CAQH import and use a mobile scanner to upload documents streamlines the data entry process, creating a significant timesaver. In addition, once their data is entered in the Medical Passport, it’s easy to maintain and access at any time, plus they receive automatic email alerts about expiring credentials.
Intelligently auto-populated applications with e-signatures mean that users complete and submit applications online, with an intuitive tool to track submissions and add follow-up dates with notes. This makes application submissions easier and faster than the old paper process. An added benefit includes the ability to have their group managers manage the process for them.
Benefit: C-Suite Oversight
Our client appreciates Acorn’s real-time graphic dashboard, which keeps C-Suite managers informed on the progress of provider applications and key critical information. There is also the ability to schedule reports to be auto-emailed to executive team members, which further streamlines the communication process.
Acorn’s automated system has helped our client integrate fragmented business processes, streamline the credentialing and enrollment process, and increase satisfaction of the credentialing/enrollment staff, providers, and executives. This has resulted in time and money savings, as well as speeding up the enrollment process which has accelerated the realization of revenue. The enrollment gains are upwards of 20% to 30% resulting in an increased revenue of approximately 2% to 4% across the organization.