Thought Leadership

New Perspectives To Improve the Credentialing Industry

Q&A: The Importance of Utilizing Key Performance Indicators (KPIs) In Provider Enrollment

Allyson Schiff, Newport VP of Operations, discusses the importance of utilizing robust Key Performance Indicators (KPIs) to improve your provider enrollment department’s performance.

Q. How do you identify which KPIs you should be using?

A. The first thing you should do is understand what are the key tasks in your Department of Provider Enrollment that you want to track, trend, and report on. Some examples include:

1. Days In Enrollment (DIE) – The DIE tracks your department and payer’s performance. The formula for calculating DIE is: Total number of elapsed days from the time your submit a paper application to a payer, compared to a standard turn around time (e.g., 90 days). If the total number of elapsed days is 120, you know the payer is not performing well. If the total number of elapsed days is 45, you know the payer is performing better than the average.

2. Department Processing Times – How long does it take your staff to data enter a provider into their credentialing system, CAQH and PECOS?

3. Provider Processing Times – How long does it take for your providers to sign their signature pages and get them back to your department?

4. In-Process Charges – What are the total number of gross charges that are associated with your in-process applications? Can you break this down by health system, hospital, clinic, provider, payer?

5. Quality – What quality metrics are your staff supposed to take when updating their payer follow up notes? Are they documenting who and when they spoke with a payer representative or what is the next action step that they need to take to obtain the PIN?

 
Q. Once you identify the KPIs you want to track, how do you begin to track them?

A. The easiest way is through technology. Check to see if your provider enrollment software will allow you to track specific KPIs. If your provider enrollment software does not allow you to track these KPIs, begin to track them manually, or via excel. The key is to track them so that you can establish performance baselines and then improve upon those metrics.

Identifying KPIs are a critical component to improving your department’s performance.

 

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