The shift away from inpatient care to care in ambulatory surgery centers (ASCs) continues to accelerate. To maintain a lower-cost site of care setting, ASC leaders now must focus on revenue recognition and optimizing labor, supplies, anesthesia and payer contract issues.
When it comes to operational efficiency, ASCs often overlook the importance of provider credentialing and payer enrollment. If new physicians are onboarded slower than expected, surgeries may need to be cancelled. As a result, revenue is lost from day one, negatively impacting the bottom line.
Rather than attempting to handle credentialing inhouse, many ASCs have decided to turn to strategic partners. To learn more about the benefits of partnering for credentialing, Becker’s Healthcare recently spoke with Claire Forgan, General Manager, Credentialing Cervices and Rachel Woodhouse, Director of Extended Credentialing Services at Modio Health.
Credentialing implications for ASCs
Credentialing impacts clinician satisfaction and ASC’s financial performance. This impact starts with the onboarding process and the collection of provider information. The goal is a smooth onboarding process so provider enrollment is complete before surgeries are scheduled.
The next step is verifying provider information. The faster this happens, the faster physicians see patients and start generating revenue. Unfortunately, verification processes can be difficult. If provider documentation isn’t clear and thoughtfully presented, it becomes a pain point for the ASC medical director or credentialing committee.
However, credentialing doesn’t stop with onboarding. Ongoing monitoring of licenses and malpractice insurance is also essential. Without that in place, ASCs can encounter compliance issues.
Given the complexities of provider credentialing and enrollment, hospitals and health systems typically have a department dedicated to this work. For most ASCs, that’s not feasible.
“At ASCs, there’s often one person handling credentialing along with office management, billing and other tasks,” Ms. Woodhouse said. “Yet, the provider complexity can be even greater, since physicians often enroll with several ASCs and move around. It’s tricky to manage that with a small staff.”
Why outsourcing matters
To decide whether to outsource credentialing or keep it in house, ASC leaders must analyze their current state of credentialing. Based on her experience, Ms. Forgan identified several red flags that indicate when outsourcing can help organizations.
The first is high staff turnover or a lack of adequate inhouse credentialing expertise.
“No one really notices credentialing until something goes wrong,” Ms. Woodhouse said. “Then ASCs find themselves in a bind. Outsourcing can prevent panic.”
Another indicator is in-house teams with poor credentialing performance. Key metrics include low approval rates and slow turnaround times. These issues can be roadblocks to rapid growth.
“When ASCs grow quickly, they need to credential providers faster. That can be very difficult without a big team,” Ms. Forgan said.
A third indicator is inconsistent demand for credentialing. If the need for credentialing is low some months but spikes in others, an outsourced partner helps manage the ebb and flow. This also frees up ASC employees, enabling them to focus on other projects.
The value of strategic partnerships
Successful partnerships for credentialing and enrolment are characterized by real-time visibility into the work, strong technology-driven processes and reporting capabilities and high-touch service.
Working with an organization like Modio Health that has U.S.-based credentialing can be great for relationship building. “Time zones can be a concern if you partner with an overseas company,” Ms. Forgan said. “With staff in the U.S., you can feel comfortable emailing, calling and getting updates in a timely manner.”
An organization with limited credentialing experience recently entered into a strategic partnership with Modio Health. Since the beginning of the engagement, Modio has reduced the turnaround time for verification by 10%. The volume of work that Modio handles for this client doubled from year one to year two, and is on track to double again by the end of the third year.
“ASCs don’t worry about credentialing until it’s not working,” Ms. Forgan said. “It’s a good idea to bring credentialing out of the shadows and include it in your planning process from the start.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
