PAYER ENROLLMENT FUNDAMENTALS APRIL 24, 2019

PAYER ENROLLMENT FUNDAMENTALSAPRIL 24, 2019

Donna Goestenkors, CPMSM - President

Nicole Keller, MSHM, CPHQ, CPHIT -Corporate Quality Assurance Officer

Team Med Global Healthcare Consulting

PROGRAM FACULTY

Donna Goestenkors, CPMSM

43Years of Service

PROGRAM FACULTY

Nicole Keller, MSHM, CPHQ, CPHIT

15+Years of Service

EDUCATION PARTNERS

• Describe the important tools needed to assess the effectiveness of the payer enrollment process.

• Identify how to implement best practices to gain enrollment proficiency, improve performance that will positively affect the bottom line.

OBJECTIVES

PREARE YOURSELF

ACTIVITY

VERBOLOGY

MSP CORE COMPETENCE

CAREER

PERSONAL/PROFESSIONAL

Effectiveness

SKILLSEfficiency Core:

~Credentialing Management~Privileging Management

~Practitioner Competence Mgmt.{privileging, FPPE, OPPE}

~Compliance Management~Enrollment Management

~Healthcare Quality Data Management~Practice Management

~Managed Care Management~On/Off-Boarding Management

~Office Management~Consulting Management~Document Management

~Merger/Acquisition Management~Lean Management

~Technology Management~Relationship Management~Development Management

Credentialing

ENROLLMENT IS NOT…

DEFINITIONS

FUNDAMENTALS

Where is Enrollment performed in your organization?• Credentials Verification Organization• Medical Staff Services Department• Practice Management• Revenue Integrity Department• Executive Contracting• Compliance Department• Billing Department• Outsourced

WHERE…

What modality do you use to Enroll?• Paper/Manual

• Fillable Forms

• Adobe Acrobat Pro

• Payer Web Portals

• Credentialing Software

WHAT…

How does your organization Enroll?

• Delegated Agreements with Payers

• Type II NPI

• Type I NPI

HOW…

How does your organization Enroll?• Prepare/Submit Enrollment Applications

• Individual/Group

• CAQH

HOW…

Who does your organization Enroll?

Individual vs. Group Provider:• Depends on who the billing will go through (Individual

NPI or Group/Org Tax ID).• If enrolling Group, individual needs to also be enrolled

and benefits are normally assigned to the Group.• Identify your organization’s internal enrollment

processes before starting.• Identify desired health plans to enroll in.

WHO…

Who does your organization Enroll?

Examples of provider types:• Medical Providers - MD, DO, PA, NP• Behavioral/Mental Health Providers• Home Health Agencies• Durable Medical Equipment (DME) Providers• Radiology/Imaging Providers• Pharmacy Providers• Independent Diagnostic Testing Facility (IDTF)• Dental Providers

How long does the Enrollment process take?• Processing times vary by payer – contact the plan and

ask!• Depending on the payer, can take 30-180 days.• Out of State applications can take longer than In State

applications.

HOW…

When will the Enrollment process be completed?• Stakeholders

• MSPs/Enrollment Specialists

• Practitioner

• MSP

• Enrollment Specialist

WHEN…

When do providers need to revalidate?• Medicare – 3-5 years depending on provider type• Medicaids – In State vs. Out of State• Private/commercial payers – can vary, usually follow

Medicare and/or Medicaid guidelines

WHEN…

WHEN SHOULD I START?

WHAT IS THE PROCESS?

ENROLLMENT PROCESS MODEL

• Expired licensure/insurance• Use of correct forms/versions• Errors/omissions on applications• Missing supporting documentation• Provider type-specific requirements for enrollment• Additional requirements for Out of State enrollments• Signature/date on applications (if applicable)• Lack of response to payer requests for more

information• Responses from providers for additional information• Expired passwords for payer web portals

THINGS TO WATCH FOR…

Using a Technology Solution• Automate/streamline/expedite

• Increase in productivity

• Reduce/eliminate redundancy

• Reduce reliance on paper

• Reporting capabilities w/stakeholders

• Better communication/transparency

• Informed decision making

TECHNOLOGY BENEFITS…

Enrollment Management• Federal Requirements

• Health Plan Requirements

• Resources

• Technology

• Stakeholders

MSP VALUE

Where can you turn for help?• Medicare websites – Medicare.gov, CMS.gov• State Medicaid websites, Medicaid.gov• Decision Health• Directory of US Health Plans – AISHealth.com• Payer Enrollment Institute/Team Med Global

Healthcare Consulting• Sonoma Credentialing Services• NAMSS/State Association’s• Peers

RESOURCES

POWER THOUGHT!

SPEAKER CONTACT INFORMATION

Donna Goestenkors, CPMSMTeam Med Global Consulting, LLC

Email: Donna@TeamMedGlobal.comPhone: (618) 830-0057

Website: TeamMedGlobal.com

facebook.com/TeamMedGlobal

linkedin.com/DonnaGoestenkors

twitter.com/TeamMedGlobal

SPEAKER CONTACT INFORMATION

Nicole Keller, MSHM, CPHQ, CPHIT

Corporate Quality Assurance OfficerINCYTE DIAGNOSTICS

Email: nkeller@incdsx.comPhone: (360) 927-5291

THE MSP YOU ARE MEANT TO BE!

SERVICE LINE

o Payer Enrollment Institute

Research

Field Interviews

Lisa Deterding

o PowerPoint Design Consultant

RESOURCES

CAREER DEVELOPMENT RESOURCE

Features include: Frequently asked questions by

MSPs Sample job descriptions,

systematic Assessment tools, planning

techniques, and strategies for effective performance

Real-life stories to illustrate specific points

Order your copy today by emailing: donna@teammedglobal.com

CREDENTIALING TOOL

Order your copy today online by visiting: www.teammedglobal.com

TMG – NATIONAL PRESENCE

MSP CREED

MSP CODE OF CONDUCT

COLLABORATION MAKES MAGIC

THANK YOU!

SERVICE LINE

o Payer Enrollment Team

Research

Lisa Deterding

o PowerPoint Design Consultant

RESOURCES

CAREER DEVELOPMENT RESOURCE

Features include: Frequently asked questions by

MSPs Sample job descriptions,

systematic Assessment tools, planning

techniques, and strategies for effective performance

Real-life stories to illustrate specific points

Order your copy today by emailing: donna@teammedglobal.com

CREDENTIALING TOOL

Order your copy today online by visiting: www.teammedglobal.com

TMG – NATIONAL PRESENCE

MSP CREED

MSP CODE OF CONDUCT

TMG GLOBAL NEWSLETTERS & BLOGS

THANK YOU!

PAYER ENROLLMENT FUNDAMENTALS APRIL 24, 2019

Documents

Transcript of PAYER ENROLLMENT FUNDAMENTALS APRIL 24, 2019

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