The importance of data management in health care environments can’t be overstated. Especially during complicated processes like credentialing, license renewal, and provider enrollment, provider data accuracy is essential to prevent costly credentialing delays, potential termination of delegated contracts or other penalties. Utilizing a data management service provider with experience in the health care industry can help keep certain credentialing and provider enrollment functions in-house while ensuring vital provider information remains updated and accurate.
Key Takeaways:
- Failure to keep provider or facility credentialing data updated and accurate can impact hospital privileges, license renewals, and possible termination of delegated contracts
- Using a third-party service provider to manage provider data ensures it remains accurate and complete throughout the credentialing, licensing, and provider enrollment process
- Combining in-house credentialing with outsourced data management gives staff more time to enhance patient care and satisfaction
- Delays in the license renewal process or other credentialing activities caused by incorrect information or overlooked expiration dates can cause negative impacts to downstream revenue
- Partnering with a third-party service provider can allow your organization to outsource time-consuming but essential tasks like primary source verifications, CLIA certificates, EFT/ERA updates, payer directory updates, CAQH Profile updates, Medicare and Medicaid revalidations and more
Complicated Processes Hampered by Data Management Issues
In the health care industry, time is money. Maintaining provider records is key to keeping critical functions moving forward in a health care environment, such as application submissions, renewals, updates and attestations that rely on accurate information to remain compliant with credentialing entities. Staff can become overburdened keeping manual records and databases up-to-date, leading to mistakes and missed deadlines that can cause a negative impact on revenue cycles.
Overlooked expiration dates, missed renewals and inaccurate or out-of-date information, like outdated insurance provider directories, can compound, bringing about severe ramifications, loss of revenue and possibly resulting in the termination of payer contracts, licenses, or clinical privileges. The provider could also be termed from health insurance plans, resulting in higher patient co-payments.
Licensing boards impose continuing medical education (CME) credits that must be tracked, which can impact a provider’s renewal of licensure if the requirements are not maintained. For example, physicians in Illinois must earn 150 hours of CME credit in a three-year re-licensure period. In 2023, Illinois requires four topic areas for CME: Safe Opioid Prescribing Training (3.0 hours), Sexual Harassment Prevention Training (1.0 hour), Recognizing Dementia (1.0 hour) and Implicit Bias (1.0 hour). The addition of CMEs counts toward the 150 hours of CME. Other states will require their own set of CME requirements that also need to be tracked.
Provider Data Managed Services Reduce Staff Burden
Outsourcing health care data management can help to ensure staff’s time is being spent efficiently. Provider data management platforms can be automated to track expiring documents, licenses and other certifications to ensure provider compliance and timely credentialing renewals. Managing these documents is only a small part of what these third-party consultants can do for your organization.
Provider data accuracy will be verified to ensure applications and renewals proceed smoothly and without interruption. Outsourced provider data management can create more flexibility while keeping other operations in-house to promote cost savings.
In addition to provider data management, third-party service consultants can perform additional tasks that would have fallen to staff. For example, Anders Health Care Advisors can manage the following recurring tasks and projects:
- EFT/ERA updates
- CLIA updates
- CAQH profile is reviewed, updated and attested at least every 120 days
- Payer directory updates and attestations at least every 90 days
- Maintain Managed Medicare and Medicaid rosters
- Medicare and Medicaid revalidations
- Commercial payer updates and renewals
- License (medical or professional) maintenance
- Medical Staff Office completion of reappointment application(s) and primary source verifications
- Retrieval and management of expiring documents
Anders Makes Outsourcing Simple and Cost-Effective
Anders Health Care offers outsourced credentialing, licensing, provider enrollment, and health care consulting services in addition to the data management mentioned above. Fully outsourcing the credentialing and provider enrollment process may not work for every business, so Anders provides other managed services supporting in-house credentialing and provider enrollment.
By leveraging practitioner and provider data management platforms, our experienced health care advisors can eliminate redundancies that commonly occur during the data collection process. With our unique, automated process to track licenses and other important renewal dates, we can create customized notifications and alerts designed to keep your organization compliant with hospital medical staff office, licensing board and payer requirements.
A seamless onboarding process is also possible with outsourced provider data management. With our unique matrix tool managing each step of the provider onboarding process, Anders can track and organize essential documents while providing continuous communication with credentialing entities. This ensures all processes keep moving forward while our automated notification system alerts us to potential roadblocks or other delays.
Onboarding new providers is time-intensive and potentially burdensome for staff to handle in-house. Outsourcing data management can help speed this process along, getting physicians back on the front lines where they can provide excellent patient care while providing a positive impact on your organization’s revenue cycle.
Anders Health Care Advisors work closely with clients to ensure health care facilities can focus on excellent patient care and safety without worrying about compliance issues. Outsourcing parts or all the credentialing and provider enrollment processes can provide new opportunities of growth for your organization. Learn more about how our advisors can help and the associated fees by requesting a meeting with an Anders advisor below.
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