Patient Financial Services, Operational Excellence work together to solve provider enrollment problems

Penn State Health’s Patient Financial Services Department and Operational Excellence Program Office teamed up on a project that saved the health system thousands of dollars in provider enrollment claim adjustments.

The goal of the project was to evaluate the process used to enroll new providers in the Medicare and Medicaid programs.

“Operational Excellence really challenged us to question our process and look at things differently,” said Lori O’Neal, Patient Financial Services team manager and project lead.

Physicians must enroll in the Medicare program to be eligible to receive Medicare payments for covered services provided to beneficiaries. Before the new protocols were put in place, providers would see Medicare and Medicaid patients, but because they were not all enrolled with those programs at the time of the services, charges were denied and written off.

The provider enrollment improvements began in October 2016 and were completed in May 2017. In Fiscal Year 2015, provider enrollment adjustments were $339,000. In Fiscal Year 2016, that figure more than doubled to $681,000. After implementing the new process in May 2017, write-offs decreased to $464,000. In the last fiscal year, they dropped dramatically to $83,000.

“It’s a huge improvement,” said O’Neal.

The Medical Staff Office now sends provider information to Patient Financial Services earlier, which allows them to enroll new physicians prior to their start dates.

Patient Financial Services worked with Human Resources and the credentialing office to successfully complete the project. The provider enrollment project had long been on O’Neal’s radar.

“We knew we could improve but never had the time to sit down and really work on a plan of action,” she said. “The Operational Excellence team’s help allowed us to do that. Sometimes in the midst of everything else it’s hard to take a step back and look at the whole process.”

The Operational Excellence Program Office develops innovative solutions to challenges that Penn State Health faces as an organization.

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