Credentialling Inefficiencies, Backlogs Create 'Revenue Leakage'

Nearly one-third of providers say the turnaround time for primary source verifications takes one month or longer. 

Clinician credentialling remains a pricey sticking point for many providers, nearly half of whom say that error-prone, manual processes they often rely on are costing them money, a new report shows.

Medallion, the San Francisco-based credentialling and provider network management company, says 46% of the 337 provider-based healthcare businesses that responded to its survey reported that inefficiencies in enrollment workflows created costly delays that adversely affected their bottom lines.

"This report dives into how much time is spent on administrative tasks rather than patient care," Derek Lo, CEO and founder of Medallion, said in a media release. "It also highlights the collective optimism and support our industry has for technology solutions that help speed up these processes and eliminate wasteful tasks."

While noting that the timeliness of reimbursements depends upon the payer, Lo says providers aren't helping the process with slow turnaround times from onboarding to application submissions.

Ultimately, the report notes, nearly one-third of respondents say the turnaround time for their end-to-end primary source verifications takes one month or longer. 

The report also notes that:

• 52% of respondents reported entirely manual credentialing workflows, including provider data collection, application receipt, credential file creation, review, primary source data verification, committee evaluations and approvals.
   
• Nearly 40% of providers reported moderate reliance on manual processes in their payer enrollment workflows. Beyond that, 69% of providers rely on two or more software tools to complete enrollment.
   
• 57% of providers saw turnover and staffing challenges in their credentialling teams during the past year. The report notes that turnover in credentialling is higher than in other healthcare administrative areas, and that these staffing fluctuations delay credentialling, delay in-network patient care, and delay payments.
   
• Nearly 60% of respondents spend more than four hours on primary source verifications, which are only a single step in the multi-step credentialing process.