The health system revenue cycle is a complex process, starting with registration and scheduling, and ending with claims submitted and processed and payments received. Removing bottlenecks that prevent faster receivables has been a constant challenge facing revenue cycle leaders. Missing providers in EHRs is a major root cause of bottlenecks and rework. The advent of promising new digital provider enrollment workflows may, someday soon, eliminate them.
Healthcare, like other industries, measures outstanding receivables using “days sales outstanding” (DSO), measuring the numbers of days on average between care delivery and payment received. While care delivery teams appropriately get the glory in improving patient health, the revenue cycle team is invaluable to a system’s financial health. A health system is only healthy if collections are timely, revenue is maximized, and cash flow is positive.
DSO rates vary wildly across industries. Retailers are paid by consumers in real-time. Some manufacturing sport DSOs under 30 days, while the most efficient healthcare system DSOs are just under 40. Hospital DSOs can stretch to 60 or 70 days. The bigger the number, the more cash is tied up, the less working capital a health system has.
Start at the Start….to Uncover and Solve Root Causes of Receivables Breakdowns
Why the delays? While management may focus on the revenue cycle’s end stages, sources of delay are found at the front end. Early-stage errors are costly, causing cash flow delays and downstream rework, requiring teams to fill in information not captured up front.
A substantial percentage of delays in receivables are due to missing provider information not available at scheduling or registration. When a provider is not found, IT must manually create new provider profiles with incomplete information, creating a laborious loop of bad provider information. Downstream, the incorrect provider address, phone, fax or missing NPI or specialty information require research and data entry in order for IT to create the profile. Missing provider information can represent 10-20% of delayed receivables.
The Profound Impact of ‘Provider Not Found’
All too often, the patient access or call center staffer looking up a provider to add to a registration record in their EHR gets the dreaded “Provider Not Found” message.
When the ‘Provider Not Found’ message – universal regardless of system – occurs, what options do staff have? None, really. Staff leave the provider fields blank and move to the next patient.
The missing provider now becomes Someone Else’s (Downstream) Problem – usually the HIM or revenue cycle team (and IT – we’ll get to them later). The registration becomes a claim. Someone Else must chase down the missing information and enroll the provider in the EHR and attach the provider to that particular record. It can take a half hour or more for staff to research a single provider online, searching CMS, NPPES, state-level medical boards and even Google to correctly identify the full name, NPI, specialty and correct clinical (not billing) address for “Dr. Smith.” Phone calls may have to be made to a practice to confirm an address and that the patient received care at that location, and not the other two offices at which the referring provider practices. All claims that are missing providers end up in a queue, where they may sit for weeks. The good news is that a claim won’t feel lonely. There are always lots of them.
IT is impacted by every ‘provider not found.’ At least one major EHR vendor only allows certified IT staff to enroll providers in their system. Claims sit until a skilled IT person finds time to enroll missing providers into the EHR. The provider enrollment IT process may be 30 or more steps. Some health systems maintain a staggering backlog of providers to enroll; several we recently visited had thousands of data entry tickets awaiting provider enrollment.
‘Provider not found’ affects other EHR-based workflows, including referral management. Completing a referral at the end of a patient encounter grinds to a halt when the desired provider is missing in the EHR. The missing specialist similarly becomes Someone Else’s Problem. Missing providers can potentially impact referral-related revenues and the operational agility of the entire enterprise
Fix the Problem at the Source: Enroll Missing Providers When They’re Missing (Not a Month Later)
Health systems that embrace “six sigma” or “lean processes” subscribe to a “do it right the first time” ethos. Fixing revenue cycle breakdowns at the source can have, as shown above, profound cash flow and time savings benefits.
Imagine revenue cycle where everything was correctly done the first time. What would it look like? It would start with always-complete patient registrations. ‘Provider not found’ in Epic or Cerner? No worries! The registration, scheduling, or call center staff would find the provider in an authoritative source and enroll them instantly in the EHR. How does this happen? Transform your providers and physical structures – physician practices, imaging centers, labs – into a single digital platform.
Such a platform would make possible game-changing workflows such as real-time provider enrollment, generating significant operational impact. No more missing providers. No more downstream research. No data entry tickets for IT. One problem solved!
What are the requirements of such a system? It would need to include:
- A single digital footprint containing profiles of all health system providers and locations;
- A national provider network of all providers, searchable in real-time;
- Robust provider profiles including full name, NPI, address, and specialty;
- Provider search of national network is accessible in the EHR when ‘provider not found’;
- Provider search available for patient access, reg/sched, call center, referring users; and
- Real-time provider enrollment into the EHR during registration or referral management
The benefits of this workflow would include:
- Always-complete registration, scheduling, referral workflows – no missing providers;
- Elimination of the dreaded ‘provider not found’ error;
- The end of time-consuming research by revenue cycle and supporting teams;
- Elimination of tickets to IT teams requiring data entry;
- Dramatic reduction of DSOs as the delays for provider enrollment are eliminated; and
- Protection of referral management revenue.
The good news for health care finance leaders is that a class of provider-centric platforms are emerging which work in conjunction with EHRs and can offer this workflow. This software platform class transforms and maintains a health system’s care delivery assets – credentialed and referring providers, locations, health plans, and networks – into a single digital footprint that serves revenue cycle teams as well as other departments including digital marketing, value-based care, IT, and compliance.
The combination of a provider-centric platform integrated with an EHR, patient access or call center system to offer real-time provider enrollment ‘on the fly’ may well make ‘provider not found’ extinct in the near future, and permanently remove one major source of revenue cycle bottlenecks.