Provider enrollment: A new competency for MSPs to master
Provider enrollment should be on MSPs’ radars, if not yet on their dockets, according to Carol Cairns CPMSM, CPCS, advisory consultant with The Greeley Company and president of PRO-CON, an Illinois-based medical staff services consulting group, and Maggie Palmer, MSA, CPMSM, CPCS, a medical staff consultant based in Dallas. According to the Credentialing Resource Center's 2016 MSP Salary Survey, 32.1% of respondents reported that their department performs both medical staff services and provider enrollment tasks. This significant percentage of double-duty departments reflects a sea change in and beyond the medical staff services field, says Cairns. “In the old days, nobody in the organization did provider enrollment—nobody.”
Historically, a hospital’s medical staff consisted of independently practicing physicians, fellow practice partnerships, and group practices who held privileges—but rarely contracts—with the institution. In contrast, today’s agreements between physicians and hospitals can include a variety of convention-defying provisions that reflect the healthcare industry’s move toward integration. In particular, physician employment and increased contracting have emerged as promising alternatives to traditional relationships.
The arrangement often shifts administrative burdens—like health plan enrollment and service billing—from the physician to the hospital. And any seams in these processes can cost the institution big bucks by delaying a new hire’s start date or triggering claim denials for care provided before requisite vetting processes have concluded.
To prevent such losses, employing institutions are searching for ways to streamline practitioner vetting. Strategies include bringing provider enrollment in-house, or, in organizations where enrollment is already handled internally, moving the task under the medical staff services umbrella.
Cairns has experienced a change of heart about this latter tactic. When provider enrollment first appeared on the medical staff services scene, she discouraged her clients from taking part in the activity, viewing it as a distraction from the profession’s tried and true functions. Now, she considers enrollment an emerging competency area for MSPs committed to keeping pace in healthcare’s march toward integration. “My new song is, you need to care,” says Cairns. “That’s the new world that’s out there, and hospitals are employing more and more doctors, and I don’t see it going the other way any time soon.”
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