National Credentialing Forum - 2018 Vicki L. Searcy Data Integrity: The Value of Integrating Quality into Your Organization’s Payer Enrollment Activities National Credentialing Forum - 2018 Vicki L. Searcy

What’s on the horizon for 2018? Artificial intelligence is hot There is great financial anxiety Sometimes not enough nurses, sometimes too many employees Increasingly, high turnover is a CHOICE The quest is on for a single, accurate provider database Don’t call us a hospital system Gen Y is taking over the workforce Cybersecurity issues are alarming CMS is changing course We need to expect the unexpected

ENROLLMENT: Efficiency and Automation Are High Priorities PROVIDER ENROLLMENT: Efficiency and Automation Are High Priorities Echo and Morrissey Thought Leadership Series: 2017 Report on Industry Needs Healthcare’s Leader in Workforce Development

Survey Background Survey results contributed to composing the Spring 2017 – Provider Enrollment survey was conducted by Echo and Morrisey, A HealthStream® Company (Now Verity) 37 Questions focused on Provider Enrollment 505 respondents - Hospitals, Health Systems and Medical Groups Survey results contributed to composing the 2017 Report on Provider Enrollment: Efficiency and Automation are High Priorities

Why Focus on Enrollment? Enrollment = Reimbursement Reimbursement = Money Thus, Enrollment = Money Health Care Organizations are actively seeking Solutions to Improve processes Decrease enrollment timeframes Improve revenue stream

Why Focus on Enrollment? Time is Money when onboarding providers $6,641 in daily opportunity potential (what a physician could bill)* per day ($1,560,688 divided by 235 = $6,641.23) $1500 estimated daily physician cost ** If you save 1 day in time = $5,141.23 (Daily opportunity potential minus daily physician cost) If you reduce your TAT by 15 days = $77,118.45 Per Provider *Source: 2016 Merritt Hawkins Physician Inpatient/Outpatient Revenue Survey **Source: StaffCare, A Company of AMN Healthcare – based on average locum tenens data/cost

Top Five Major Challenges The volume of forms and enrollment is the number one challenge. (37.5%) Challenge # 2 Trouble collecting information from provider needed for enrollment. (34.1%) Challenge # 3 Knowing when changes are made within my organization or by a provider. (31.0%)

Top Five Major Challenges Keeping provider information up to date with payers. (25.7%) Challenge # 5 Number of providers onboarded each month. (25.2%)

CMS Guidelines for accuracy of provider information Provider directories must contain relevant and accurate provider information. This will be implemented through directory maintenance through monthly updates of provider information and quarterly touch points with providers within a Qualified Health Plan network. CMS is currently auditing healthcare organizations for accuracy. Penalties may be forthcoming.

2016 Medicare Advantage Audit by CMS (Results published in January, 2017) Findings: Significant inaccuracies in provider data provided to Medicare Advantage enrollees. Inaccurate data included The provider was not at the location listed The phone number was incorrect The provider was not accepting new patients when the directory indicated they were

Bad data is expensive According to AHIP (America’s Health Insurance Plans), inaccurate provider data results in over $40 billion in additional administrative expense annually.

Why is Provider Data Quality so Poor Why is Provider Data Quality so Poor? How can this Problem be Alleviated? Lack of defined data elements (no data dictionary) Problem of where a provider will be seeing patients starts with onboarding – in many organizations, it is very difficult to find out where a new provider will be practicing Too many players in provider database Many health systems have centralized their credentialing process – but in these health systems, enrollment may be fragmented If an organization has an established CVO and limits access to shared data, data quality is typically better If not CVO and data comes from credentialing process, it is coming from people who typically do not understand/care about the ramifications of incorrect addresses Depending upon people to report changes – not a priority in many cases

Potential Solutions Data dictionary Assign responsibility for identification of where providers will be practicing Limit ability to enter and update critical data Assign responsibility for maintaining address information to those who understand the implications Alert via EMR of provider at a new site Inability to access EMR at practice site where not enrolled