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Medical Staff Credentialing Departments Manage only about 20% of a Hospital’s Provider Base

By Blake Marable | September 16, 2015

Credentialing departments are empowered to manage the background verifications and privileging process at healthcare facilities. Using various credentialing systems, they are excellent at managing this background review of the providers who are on staff.

However, credentialed providers make up the smallest segment of the provider base that feed revenue into a healthcare facility. In fact, 80% of providers are referring physicians from all over the country. Additionally, the referring population within healthcare organizations is growing at 10% to 30% annually. There are several reasons for this growth: hospital/clinic acquisitions, expansion plans, ACOs and the general growth of patient travel.

Without the appropriate information on referring providers, revenue cycles can break down. The impact for small facilities is millions of dollars in delayed billing; for larger systems this can run into the hundreds of millions. EMRs are not answer because of their patient centric approach. They are excellent at managing the healthcare delivery process from admission to discharge. However, at the point of discharge, poor provider data (inaccurate physical addresses, multiple Direct Addresses) will significantly impact the revenue cycle. EMRs, by design, offer only limited tools to manage provider data quality.

What health systems need is an enterprise platform to unify, manage and share all provider information. Phynd is not a credentialing system, but it complements these systems by integrating with them and ensuring there is accurate data on all physicians (credentialed and referring) enterprise-wide.

The Phynd Unified Provider Management (UPM) Platform allows healthcare organizations to unify, manage and share a single, verified, custom profile on each of their providers, regardless of where that data exists in their multiple, legacy IT systems. Phynd has a proven model to speed up billing, improve clinical communications/quality and improve productivity.

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