The Situation: The number of employed practitioners at your hospital is increasing. Provider enrollment with the managed care payers is time-consuming and long delays are being encountered. A significant loss of revenue has been incurred over the last year due to the inability to bill for patient care services while your practitioners waited to be credentialed by the payers. Administration has come to you, the medical services professional (MSP), to discuss options on how to address this issue.
The Solution: Delegated Credentialing in the Medical Staff Services Department (MSSD)
Now I know some of you may have that “deer in the headlights” look. Delegated Credentialing? Provider Enrollment? Managed Care Payers? NCQA? URAC? This may seem like a foreign language to many MSPs.
Commercial payers have been delegating credentialing activities to a variety of organizations, including IPAs, PHOs, CVOs, medical societies, even other health plans, to achieve greater efficiencies. However, a growing trend observed by The Greeley Company is for payers to delegate credentialing to hospitals and health systems due to the increased integration between medical staff services and provider enrollment for employed practitioners.
MSSDs typically have been known as a cost center only. But now MSPs can embrace a new opportunity to play an integral role in supporting their organization’s financial position. With the growing numbers of employed practitioners, hospitals and health systems are looking at delegated credentialing to speed up the provider enrollment process and avoid delays in receiving the revenues from payers for the services provided to patients. And since these employed practitioners are already credentialed and privileged at the hospital, it makes sense to leverage that existing function to achieve a more efficient provider enrollment process through delegation.
However, obtaining delegated credentialing from payers is not always that easy. The payer has to ensure that the hospital is performing credentialing under NCQA or URAC standards and this is an area where many hospitals struggle due to the fact that their credentialing policies are not specifically designed to meet those standards. While there are many similarities in the verification process, there are other requirements that are quite different from hospital accreditation standards, including a well-documented credentialing program structure, practitioner rights, and office site quality, to name a few.
But this is a challenge that can be overcome with the expertise and support of The Greeley Company. Our consultants are experienced in NCQA standards, delegated credentialing, and provider enrollment. We can help your organization achieve its goals to increase efficiency with credentialing operations and reduce accounts receivable write-offs due to credentialing delays for its employed practitioners.
Is your MSSD ready to take on delegated credentialing?
If you should have any questions or concerns, please feel free to contact us at 888-749-3054 or by submitting an inquiry here.