Written by: Ray Jorgensen, Co-Founder of PMG Credentialing

Multiple times each day, PMG Credentialing staff are asking healthcare leaders questions. The most common: 

What are the biggest challenges facing your organization  around Credentialing and Provider Enrollment?

This powerful question generated some interesting responses so much so we started tracking them. In this article we dig a little deeper into the top three responses. All three are closely related and intertwined. The Top three:

1.    Resource Constraints

2.    Provider turnover

3.    Compliance

Let’s dig a bit deeper to afford some perspective. 

Resource Constraints was the clear cut winner. Too much to do with too few staff, never mind the ones with the necessary skill set to be successful. Healthcare  credentialing and enrollment staff are often a combination of long-tenured, well-experienced staff with requisite experience and knowledge coupled with less experienced/tenured team members with expertise perhaps in billing or HR but not credentialing and enrollment. While the department lead is almost always terrific, the down line staff skill set is questionable, limited, or nonexistent. As an organization grows the number of providers and clinic locations, this inexperience can be devastating and costly. Equally as challenging is the sudden departure of the the department head. When s/he leaves so also does corporate knowledge and know how. Aside from this knowledge deficit looming cash flow concerns follow closely behind. Delayed or unsuccessful third-party payer enrollment means lost money due to unbillable visits without hope of a retroactive effective date. Finding a new lead in this new “remote work force” economy is compounded by metropolitan teams fighting to retain the limited number of truly experienced leaders and the rural markets convincing someone to relocate or slowly building knowledge and skills from within. 

Provider turnover was second and a common health center challenge. Whether providers leave after maximizing loan repayment or for a better paying opportunity, finding replacements is challenging. gain connected to the other issues discussed here. This omnipresent issue is made worse post COVID PHE due to clinical staff burn out. Everyone wants to work fewer hours or see fewer patients for the same pre-PHE compensation package. This is new normal is not going anywhere soon. Increased credentialing/enrollment resources are needed at peak times/deadlines. These staff are superfluous the remainder of the year, a luxury few healthcare entities can afford. Every healthcare provider abhors this difficult situation as bottom lines tightly monitored.

Compliance was third but very nearly number two. Compliance with governmental and commercial payer regulations is always on the mind of administration and C-suite. Whether a HRSA site visit, ISO or NCQA evaluation, or a third party payer audit mitigating risk is a perpetual focus of all teams. Healthcare leadership must assure all staff understand and follow of Compliance related initiatives. Mitigation of this compliance risk is often achieved by partnering with an external third party. Whether full or partial outsourcing, using an external resource either fills a knowledge deficit or a staffing void. Interviewed leaders often conveyed their team were generalists around most compliance-related issues yet, master of none. 

These top three issues rarely change except, occasionally, for priority order. These issues require carefully managed attention, constant review, and perpetual change management skills as rules seem to always morph. No easy fix exists and significant downside results if not monitored constantly. 

If your organization has any question or uncertainty, give PMG Credentialing a call for a free consult. Worst case, you will have the affirmation you need that all is well. And, if you need assistance, you called experts who can make it happen.