PAYER ENROLLMENT FUNDAMENTALS APRIL 24, 2019

© 2019 All Rights Reserved

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

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43Years of Service


PROGRAM FACULTY

Nicole Keller, MSHM, CPHQ, CPHIT

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15+Years of Service


EDUCATION PARTNERS

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• 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.

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OBJECTIVES

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PREARE YOURSELF

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Presenter

Presentation Notes

Dina comment: I like the message but think this slide resolution is too blurry, esp when viewed in “Slide Show.”


ACTIVITY

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VERBOLOGY

Presenter

Presentation Notes

Employees use a list of powerful verbs to stimulate ideas about how their work makes a difference in people’s lives. This is a great motivator and helps participants to see the value of their hard work. Before session, write the following 10 words on a flip chart: Elevate, Inspire, Motivate, Impact, Accomplish, Create, Boost, Contribute, Delight, Serve This list provides 10 of the most powerful and positive verbs in the English language. Because the success of any organization (or team) lies in its ability to achieve these goals – not in what it merely intends to do – the objective of this activity is to identify ways in which your organization succeeds. Divide into group with flip-charts and give them 10 minutes to come up with ways in which their work – via the products and services of your organization – achieves these aims for customers, employees, organization, community, and the world at large. After 10 minutes, ask each group to report its responses. Scribe and email out to participants.


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MSP CORE COMPETENCE

CAREER

Power

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

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Credentialing

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ENROLLMENT IS NOT…


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DEFINITIONS

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FUNDAMENTALS

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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…

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

• Fillable Forms

• Adobe Acrobat Pro

• Payer Web Portals

• Credentialing Software

WHAT…

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How does your organization Enroll?

• Delegated Agreements with Payers

• Type II NPI

• Type I NPI

HOW…

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

• Individual/Group

• CAQH

HOW…

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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…

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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

WHO..

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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…

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When will the Enrollment process be completed?• Stakeholders

• MSPs/Enrollment Specialists

• Practitioner

• MSP

• Enrollment Specialist

WHEN…

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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…

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WHEN SHOULD I START?

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WHAT IS THE PROCESS?

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ENROLLMENT PROCESS MODEL

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ENROLLMENT PROCESS MODEL

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• 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…

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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…

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Enrollment Management• Federal Requirements

• Health Plan Requirements

• Resources

• Technology

• Stakeholders

MSP VALUE

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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

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https://medicare.gov/

https://cms.gov/

https://medicaid.gov/

https://aishealth.com/


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POWER THOUGHT!

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SPEAKER CONTACT INFORMATION

Donna Goestenkors, CPMSMTeam Med Global Consulting, LLC

Email: [email protected]: (618) 830-0057

Website: TeamMedGlobal.com

facebook.com/TeamMedGlobal

linkedin.com/DonnaGoestenkors

twitter.com/TeamMedGlobal

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mailto:[email protected]

http://teammedglobal.com

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SPEAKER CONTACT INFORMATION

Nicole Keller, MSHM, CPHQ, CPHIT

Corporate Quality Assurance OfficerINCYTE DIAGNOSTICS

Email: [email protected]: (360) 927-5291

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THE MSP YOU ARE MEANT TO BE!

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SERVICE LINE

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SERVICE LINE

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SERVICE LINE

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SERVICE LINE

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o Payer Enrollment Institute

Research

Field Interviews

Lisa Deterding

o PowerPoint Design Consultant

RESOURCES

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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: [email protected]

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CREDENTIALING TOOL

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

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http://www.teammedglobal.com/


TMG – NATIONAL PRESENCE

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MSP CREED

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MSP CODE OF CONDUCT

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COLLABORATION MAKES MAGIC

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THANK YOU!

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SERVICE LINE

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SERVICE LINE

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SERVICE LINE

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SERVICE LINE

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o Payer Enrollment Team

Research

Lisa Deterding

o PowerPoint Design Consultant

RESOURCES

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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: [email protected]

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CREDENTIALING TOOL

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

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http://www.teammedglobal.com/


TMG – NATIONAL PRESENCE

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MSP CREED

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MSP CODE OF CONDUCT

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TMG GLOBAL NEWSLETTERS & BLOGS

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THANK YOU!

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Documents

PAYER ENROLLMENT FUNDAMENTALS APRIL 24, 2019