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

2. 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

3. 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

4. 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

5. 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

6. 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: Merritt Hawkins Physician Inpatient/Outpatient Revenue Survey
**Source: StaffCare, A Company of AMN Healthcare – based on average locum tenens data/cost

7. 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%)

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

9. 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.

10. 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

11. 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.

12. 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

13. 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