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Description
Do you know that credentialing and payer enrolment are the cogs that kick-start the revenue cycle of your organization? Payer/Provider Enrollment includes the payer-specific process to enroll your organization and provider with in-network participation. In-network participation equals in-network reimbursement for services rendered. Additionally, Provider enrolment has many moving parts that must be managed successfully because your organization’s bottom line depends on it. In provider enrolment, we must successfully and continuously maintain multiple provider profiles, directories, network portals, etc. You must update and revalidate information correctly. Any missed process in the cycle can negatively impact the provider's network participation and the organization’s revenue cycle. This session will review the most common provider enrollment web portals and forms and how to manage them successfully. Expert Yesenia Servin, CPMSM, PESC will analyze provider enrolment, revalidation, and attestation and the impact they have on your organization’s revenue.
Enrolling with the Medicare program involves the various CMS-855 forms. There are now different forms that must be used by different providers of healthcare services or products. These forms are long, detailed, and sometimes confusing. Not only must they be filed initially for a given provider, they must be maintained and updated as appropriate. Due to the increasing complexity of healthcare delivery systems, providers, such as integrated delivery systems or large multi-specialty clinics, may have to maintain hundreds of these forms. Join expert Yesenia Servin, CPMSM, PESC, for this detailed review of the Medicare credentialing requirements , CMS 855 forms for Medicare participation. We will review both the paper applications and PECOS applications, Facility apps, Organization apps, and Individual apps. Failure to use the updated forms can cause outright rejection of the application and lead to significant delays in getting your providers enrolled.
Learning Objectives
- Overview of CMS connection in order to remain compliant and to successfully complete Medicare provider applications
- Medicare Credentialing Requirements
- Understand part A Facility applications
- Understand part B organization app and individual apps
- Understand reassignment apps
- To review the Medicare enrollment process through the use of the various CMS-855 forms
- To address changes to the CMS-855 forms and/or changes in interpretations of the forms
- To discuss the revalidation process for the various CMS-855 forms
- Review each section of the application within PECOS
- Know the payer-specific rules and requirements of both government and commercial payers.
Areas Covered
- Health & Affirmations
- Defined & Explained
- Credentialing
- Enrollment
- Joining the Network
- Pre-application
- Network screening
- Network invitation
- Application/Agreement
- Provider submission
- current CAQH account
- The network performs all phases of the process
- Final determination; INN or denial
- First Actions Steps
- Name
- TIN vs SSN
- Identity & Access (I&A)
- NPI
- NPPES
- Specialties
- PECOS
- CAQH
- CPT List
- Fee schedule
- I&A Identity & Access Account
- CAQH & NPI
- Documentation
- Discovery Phase: Why
- Discovery Phase: Who
- Discovery Phase: Where
- Discovery Phase: When
- Portals & Profiles
- Payer Network Portals
- Government Portals
- Private Portals
- Hospital Portals
- Clearinghouse & Directory portals
- Payer Network Portals
- Defined: Delegated & Non-Delegated
- Build Your Own Credentialing Database
- Build your own database; Excel, Access, OneNote, etc
- Everything that is listed on your CAQH profile Maintain Employment History
- New Opportunities
- More Why’s?
- Network information
- Contract ID & Login
- Communications details
- Details of pre-app submission, full agreement submission Follow-up
- Approval/Denial
- Confirmation of Fee Schedule
- I&A, NPPES login info
- Completed training/internships
- Expirable information
- CMS Connection (Access Manager) to all EINs
- Availity Connection
- Access to payer platforms, i.e., UHC, Cigna.
Who Should Attend
- Credentialing Specialist
- Revenue Cycle Managers
- Enrollment Specialist
- Hospitals
- Mental Health Providers
- LCPC
- LMFT
- Practice, Clinic Owners
- Hospital Leadership
- Authorized Officials
- Delegated Officials
- Revenue Cycle Directors
- Credentialing
- Office Manager
- Revenue Cycle
- Operations
- Billing Team
- In and Out of Network Providers
- Medical Billing Companies
- Providers Office Staff
- Physician
- Hospitals and Facilities
- Insurance Companies
- Healthcare Attorneys
- Executive and Administrators
- Front Desk
- Scheduling
- Authorizations Staff
- Medical Assistants
- Certified Nursing Assistants.
Speaker
Yesenia Servin is a nationally certified credentialing manager and provider enrollment specialist with over 27 years of experience in the healthcare industry. As an expert in credentialing and provider/payer enrollment, she has a deep understanding of Medicare & Medicaid enrollment.
Currently, Yesenia is the Director of Contracting, Credentialing & Provider Enrollment at United Vein & Vascular Centers. Through YS Credentialing PLLC, she assists organizations in developing and implementing best practices, guidelines, and processes, and guides the credentialing and payer enrollment structure.
Yesenia excels at training and mentoring administrative, credentialing, and enrollment healthcare professionals.
Her responsibilities include managing payer enrollment, keeping colleagues informed on industry trends, and serving as a liaison to all departments affecting payer-enrollment processes. She provides revenue cycle consulting services to various healthcare providers and organizations, including those focused on durable medical equipment, hospital and health systems, community mental health organizations, and global managed care organizations.
Yesenia is actively involved in professional and academic roles:
- Current Charter Oak University Faculty
- NAMSS member (and past NAMSS Educational Conference Guest Speaker)
- Current member of the NAHRI Leadership Council
- Current trainer for The Chicago School of Professional Psychology
- TMG Collaborator
She holds academic training in microeconomics and communications from NEIU and healthcare administration from Concordia University Chicago. In her personal time, Yesenia enjoys spending time with her family and pugs, and finds joy in trekking across the US states and regions.