This comprehensive webinar, led by expert Cati Harris, CBCS, is tailored for individuals new to credentialing, those involved in building a credentialing program, or anyone looking to refresh their credentialing skill set. The course covers essential topics in provider enrollment, offering valuable insights and practical guidance.
Participants will gain knowledge on provider credential verification, the setup and maintenance of crucial systems such as CAQH, NPPES, PECOS, and I&A, CV verification, application preparation, review and submission processes, identification of red flags, linking providers to existing contracts, re-verification procedures, and ongoing provider file maintenance. The webinar also includes a FAQ section and guidance on establishing a successful provider enrollment program.
As a bonus, attendees will receive multiple free printable and customizable forms for provider enrollment. The webinar concludes with a live Q&A session, providing participants with the opportunity to have their specific questions addressed. Whether you are new to credentialing or seeking to enhance your existing knowledge, this webinar offers a detailed view of provider enrollment, maintenance, and the development of successful programs.
Register,
https://conferencepanel.com/conference/a-guide-to-provider-enrollment-and-building-a-successful-provider-enrollment-program
Demystifying Provider Credentialing: Everything You Need to KnowConference Panel
Join the webinar led by expert Cati Harris, CBCS, to learn the comprehensive provider credentialing process. This webinar includes a step-by-step guide, printable and customizable forms for payer/application cover letters, provider documentation requirements, Verification of Documentation, CV requirements, application submission, payer linkage, provider revalidation, employment history, and more! You'll receive tracking tools for document verification and payer application tracking.
You'll also gain insights into setting up/maintaining CAQH, PECOS, NPPES, and Identity & Management, credentialing documentation requirements, document verification/validation, payor application requirements, and submission of payer enrollment application packages. Plus, discover the key steps to complete once the credentialing process is approved.
Take advantage of the opportunity for a live question/answer session at the end of this information-packed webinar. Join now to enhance your provider credentialing knowledge!
Register,
https://conferencepanel.com/conference/credentialing-101-detailed-guide-to-provider-credentialing
Provider Credentialing: Maintaining Provider Enrollments, Updates, and Re-Val...Conference Panel
Are you wanting to update your credentialing skill set? Do you have providers you are responsible for maintaining their CAQH and credentialing with all payers? Is it time for your provider's revalidation?
If you answered yes, then you have found the webinar made just for you!
Join expert Cati Harris, CBCS as she presents this detailed, comprehensive webinar providing you with the steps to maintain your provider's CAQH, PECOS, payer enrollments, and completing provider revalidations. This webinar features a guide to provider credentialing, maintenance of provider enrollments, and completing provider revalidations. Also includes multiple printable and customizable forms for payer/application cover letters, provider documentation requirements, Verification of Documentation, CV requirements, application submission, payer linkage, provider revalidation, employment history, and much more!
At the end of this information-packed webinar, you will have the opportunity for a live question/answer session.
Register,
https://conferencepanel.com/conference/provider-credentialing-maintaining-provider-enrollments-updates
Don’t Miss Out on Money! How to Make Sure Your Credentialing is Done Correctly.Kareo
Credentialing correctly is necessary for all practices (or your clients’ practices) to be able to accept patients and avoid delays in payment. As an independent practice, your staff is most likely facing burnout and staffing shortages are on the rise.
In this informative webinar, Melissa Isham, National Account Executive, Client and Specialty RCM Sales at TriZetto Provider Solutions will explain:
- What is credentialing and why accuracy is paramount to success
- The current state of the industry
- Major pain points and solutions for independent practices
The Medicare Diabetes Prevention Program (MDPP) Expanded Model team provided a tutorial about enrollment in the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
My updated current resume is attached. I am currently actively looking for employment opportunities with room for upward mobility. I am a qualified Medical Billing & Quality Assurance Specialist with extensive knowleof Medical Billing and Insurance Coding and Revenue Cycle Management. Worked as a liaison between the provider and insurance companies to ensure optimum and timely reimbursements for all clean claims submitted. Strive to ensure all customer service needs are always met in a professional manner.
Exploring the Revised Medicare 855 Enrollment Form for 2024Conference Panel
Navigating Medicare enrollment for mental health providers (MFTs and MHCs) in 2024 is complex and time-consuming. This webinar provides guidance on eligibility, form types (CMS 855), key terminology, required documentation, fees, PTAN linkage, common errors, and best practices. Proper understanding of application type, NPI type, PECOS requirements, taxonomy designations, and PAR vs. NON-PAR status is crucial to avoid cash flow delays and other systemic issues. With expert guidance, providers can ensure accurate submission and smooth enrollment with Medicare.
Understand the CMS 855 enrollment submission process for 2024.
Recall CMS 855A, 855B, and 855I Application requirements for 2024.
Recall the most complicated sections on the 855 applications for 2024.
Recall strategies to complete 855 forms accurately for 2024.
Recall ancillary documentation required with 855 enrollment submissions for 2024.
Avoid common rejections and errors with 855 form submissions.
Recall best practice tips for 855 form submissions for 2024.
Register,
https://conferencepanel.com/conference/navigating-the-2024-medicare-855-enrolments-form-updates
Provider Credentialing - Overview and ChecklistJessica Parker
Provider credentialing is a process in which a provider's qualifications and competency-based on demonstrated competence are formally assessed by a health insurance carrier.
Demystifying Provider Credentialing: Everything You Need to KnowConference Panel
Join the webinar led by expert Cati Harris, CBCS, to learn the comprehensive provider credentialing process. This webinar includes a step-by-step guide, printable and customizable forms for payer/application cover letters, provider documentation requirements, Verification of Documentation, CV requirements, application submission, payer linkage, provider revalidation, employment history, and more! You'll receive tracking tools for document verification and payer application tracking.
You'll also gain insights into setting up/maintaining CAQH, PECOS, NPPES, and Identity & Management, credentialing documentation requirements, document verification/validation, payor application requirements, and submission of payer enrollment application packages. Plus, discover the key steps to complete once the credentialing process is approved.
Take advantage of the opportunity for a live question/answer session at the end of this information-packed webinar. Join now to enhance your provider credentialing knowledge!
Register,
https://conferencepanel.com/conference/credentialing-101-detailed-guide-to-provider-credentialing
Provider Credentialing: Maintaining Provider Enrollments, Updates, and Re-Val...Conference Panel
Are you wanting to update your credentialing skill set? Do you have providers you are responsible for maintaining their CAQH and credentialing with all payers? Is it time for your provider's revalidation?
If you answered yes, then you have found the webinar made just for you!
Join expert Cati Harris, CBCS as she presents this detailed, comprehensive webinar providing you with the steps to maintain your provider's CAQH, PECOS, payer enrollments, and completing provider revalidations. This webinar features a guide to provider credentialing, maintenance of provider enrollments, and completing provider revalidations. Also includes multiple printable and customizable forms for payer/application cover letters, provider documentation requirements, Verification of Documentation, CV requirements, application submission, payer linkage, provider revalidation, employment history, and much more!
At the end of this information-packed webinar, you will have the opportunity for a live question/answer session.
Register,
https://conferencepanel.com/conference/provider-credentialing-maintaining-provider-enrollments-updates
Don’t Miss Out on Money! How to Make Sure Your Credentialing is Done Correctly.Kareo
Credentialing correctly is necessary for all practices (or your clients’ practices) to be able to accept patients and avoid delays in payment. As an independent practice, your staff is most likely facing burnout and staffing shortages are on the rise.
In this informative webinar, Melissa Isham, National Account Executive, Client and Specialty RCM Sales at TriZetto Provider Solutions will explain:
- What is credentialing and why accuracy is paramount to success
- The current state of the industry
- Major pain points and solutions for independent practices
The Medicare Diabetes Prevention Program (MDPP) Expanded Model team provided a tutorial about enrollment in the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
My updated current resume is attached. I am currently actively looking for employment opportunities with room for upward mobility. I am a qualified Medical Billing & Quality Assurance Specialist with extensive knowleof Medical Billing and Insurance Coding and Revenue Cycle Management. Worked as a liaison between the provider and insurance companies to ensure optimum and timely reimbursements for all clean claims submitted. Strive to ensure all customer service needs are always met in a professional manner.
Exploring the Revised Medicare 855 Enrollment Form for 2024Conference Panel
Navigating Medicare enrollment for mental health providers (MFTs and MHCs) in 2024 is complex and time-consuming. This webinar provides guidance on eligibility, form types (CMS 855), key terminology, required documentation, fees, PTAN linkage, common errors, and best practices. Proper understanding of application type, NPI type, PECOS requirements, taxonomy designations, and PAR vs. NON-PAR status is crucial to avoid cash flow delays and other systemic issues. With expert guidance, providers can ensure accurate submission and smooth enrollment with Medicare.
Understand the CMS 855 enrollment submission process for 2024.
Recall CMS 855A, 855B, and 855I Application requirements for 2024.
Recall the most complicated sections on the 855 applications for 2024.
Recall strategies to complete 855 forms accurately for 2024.
Recall ancillary documentation required with 855 enrollment submissions for 2024.
Avoid common rejections and errors with 855 form submissions.
Recall best practice tips for 855 form submissions for 2024.
Register,
https://conferencepanel.com/conference/navigating-the-2024-medicare-855-enrolments-form-updates
Provider Credentialing - Overview and ChecklistJessica Parker
Provider credentialing is a process in which a provider's qualifications and competency-based on demonstrated competence are formally assessed by a health insurance carrier.
Contract Management Best Practices: Tips to Maximize ReimbursementPMMC
Effective contract management systems are critical to maximizing financial performance, minimizing risk, and managing all aspects of payer contracts to get reimbursed accurately.
However, the success of a contract management system is only as strong as your processes. As changes constantly occur – such as government reimbursement methodologies – it’s important to stay ahead of the curve and ensure that your contract management system supports these changes.
In this educational presentation, Kristen Wood, Senior Account Manager - Contract Management at PMMC shares the most pressing issues today related to contract management and how your facility can maximize the use of its contract management vendor.
This presentation covers:
• The impact of registration errors
• Common billing errors (missing modifiers, late charges, etc.)
• Denial monitoring and what to look for
• Upcoming government reimbursement changes (Sequestration, ICD-10, APR-DRG for stat Medicaids) and what to expect
• Managing your A/R days and the importance of reporting
• Payer tactics and how to address them (underpayment trends, silent PPOs, LOS issues)
• False variances and how to conquer calculation challenges
Breaking Down the 2023 Medicare 855 Enrollment Form UpdatesConference Panel
Enrolling with Medicare as a provider or organization can be a challenging and time-consuming task. Despite being the largest insurer in the country, the complexities surrounding enrollment application requirements have resulted in a decline in the number of new Medicare enrollment applications.
The consequences of incorrect submissions can be severe and have systemic implications, such as delays in cash flow, credentialing issues, coding problems, denial management issues, lower patient satisfaction, and even affect quality scores.
In our informative webinar, we will explore the various options available for submitting the 2023 Medicare 855 Enrollment forms, the providers who are eligible for Medicare enrollment, the different form types, and the strategies for navigating the form sections.
We will also delve into key terminology, the ancillary documentation required with enrollment submission, applicable fees, the most common errors, and best practices for completing the CMS 855 forms.
This webinar aims to equip you with the knowledge and tools needed to successfully complete the Medicare enrollment process and avoid potential pitfalls that can have a significant impact on your organization.
Register Now,
https://conferencepanel.com/conference/navigating-the-2023-medicare-855-enrollment-form-updates
When it comes to simplifying the medical credentialing process and optimizing relationships with insurance networks, healthcare providers can benefit greatly from the services of a trusted and experienced credentialing service provider like Instapay Healthcare Services.
Provider Credentialing Steps in Medi-Cal.pptxScottFeldberg
In California, the Provider Enrollment Application is the process by which healthcare providers can enroll in the state’s Medicaid program, known as Medi-Cal. The enrollment process ensures that providers meet the state’s qualifications for participation and establishes a provider’s ability to receive payment for services rendered to Medi-Cal beneficiaries.
Provider Credentialing Steps in Medi-Cal.pdfScottFeldberg
Provider credentialing is a process by which a healthcare provider is verified to ensure they meet the necessary requirements to provide healthcare services to patients. It is important to note that the credentialing process may take several months, so it is best to start the process early.
Provider Credentialing Steps in Medi-Cal.pptxScottFeldberg
Provider credentialing is a process by which a healthcare provider is verified to ensure they meet the necessary requirements to provide healthcare services to patients. It is important to note that the credentialing process may take several months, so it is best to start the process early.
Provider Credentialing Steps in Medi-Cal.pdfScottFeldberg
Provider credentialing is a process by which a healthcare provider is verified to ensure they meet the necessary requirements to provide healthcare services to patients. It is important to note that the credentialing process may take several months, so it is best to start the process early.
Provider Credentialing Process Flow Chart.pdfScottFeldberg
Provider credentialing is a critical process in the healthcare industry, which involves the verification of a healthcare provider’s credentials, qualifications, and experience to ensure they meet certain standards set by the insurance companies.
Provider Credentialing Process Flow Chart.pptxScottFeldberg
Provider credentialing is a critical process in the healthcare industry, which involves the verification of a healthcare provider’s credentials, qualifications, and experience to ensure they meet certain standards set by the insurance companies
Top 10 Medical Billing KPIs That Show Where Your Practice is Losing MoneyKareo
Kareo’s Billing Subject Matter Expert, Terri Joy, MBA, CPC, CGSC, COC, CPC-I, shares the 10 medical billing KPIs you need to know to prevent your practice from losing money.
Practical Solutions for Managing the Coverage Gap Discount Program Paragon Solutions
Since the inception of the Coverage Gap Discount Program (CGDP), Manufacturers have been presented with challenges in managing the CGDP. There are operational, financial, compliance and legal challenges that fall across the organization.
This webcast will highlight those challenges and provide insight into practical solutions Manufacturers have employed to help mitigate these challenges.
What you can expect to learn from the webcast:
- High-Level Process Requirements needed to efficiently manage CGDP
- Practical Solutions that have been applied to mitigate challenges and risks
- How to manage the Negative Balance Solution
- Tips for preparing for the Dispute Resolution Process
- How to maximize data for Financial Analytics
Medicare and Medicaid Managed Care Enrollments in 2024Conference Panel
The process of enrolling with Medicare and Medicaid Managed Care as a provider/organization can be incredibly tedious and time-consuming. The number of new Medicare and Medicaid enrollment applications continues to decline due to the enormous complexities surrounding enrollment application requirements. The cost of getting these enrollment application submissions wrong can have systemic consequences on an organization, including cash flow delays, credentialing issues, coding issues, claims backlogs, denial management issues, patient satisfaction, and even impact quality scores.
In 2024, Medicare opened the enrollment gates for new mental health providers (MFTs and MHCs) that had previously been excluded from providing services to Medicare beneficiaries. In today's webinar, we discuss the submission options, which providers are eligible for Medicare and Medicaid enrollment, each enrollment type, how to navigate the enrollment process, key terminology, what ancillary documentation is needed with enrollment submission, applicable fees, linkage issues with PTAN numbers, most common errors, and best practice tips for successfully completing the Medicare and Medicaid enrollments in 2024.
Learning Objectives
Understand the CMS 855 enrollment submission process for 2024.
Recall CMS 855A, 855B, and 855I Application requirements for 2024.
Recall the most complicated sections on the 855 applications for 2024.
Recall strategies to complete 855 forms accurately for 2024.
Recall ancillary documentation required with 855 enrollment submissions for 2024.
Avoid common rejections and errors with 855 form submissions.
Recall best practice tips for 855 form submissions for 2024.
Areas Covered
Dissect the various Medicare and Medicaid enrollment types in 2024.
Outline a sample workflow for completing Medicare enrollment.
Outline a sample workflow for completing Medicaid Managed Care enrollment.
Review enrollment forms for Medicare and Medicaid.
Discuss the most challenging Medicare and Medicaid enrollment sections for 2024.
Discuss strategies to complete the Medicare and Medicaid enrollment forms accurately for 2024.
Review the process of reassigning Medicare benefits to organizations for 2024.
Review the ancillary documentation required with Medicare and Medicaid enrollment submission for 2024.
Discuss the most common rejections and errors with Medicare and Medicaid enrollment form submissions for 2024
Register Now,
https://conferencepanel.com/conference/medicare-and-medicaid-managed-care-enrollments
Dispelling HIPAA Myths: Texting, Emailing, and BYOD Best PracticesConference Panel
This 90-minute webinar will detail your practice (or business) information technology and how it relates to the HIPAA/HITECH Security Rule and securing PHI in transmission – what is required and what is myth… I will review multiple examples and specific scenarios and offer simple, common-sense solutions. I will also discuss the do's and don'ts relating to encryption and updated bulletins provided by the Office for Civil Rights.
Areas covered will be texting, email, encryption, medical messaging, voice data, personal devices, and risk factors.
I will uncover myths versus reality as they relate to this enigmatic law based on over 1000 risk assessments performed and years of experience in dealing directly with the Office for Civil Rights HIPAA auditors.
I will speak on specific experiences from over 18 years of experience working as an outsourced compliance auditor and expert witness on multiple HIPAA cases in state law and thoroughly explain how patients can now get cash remedies for wrongful disclosures of private health information.
More importantly, I will show you how to limit those risks by taking proactive steps and utilizing best practices.
Don't always believe what you read online about HIPAA, especially regarding encryption and IT; many groups sell more than necessary.
Register Now,
https://conferencepanel.com/conference/2024-hipaa-texting-and-emailing-dos-and-donts
More Related Content
Similar to Provider Enrollment Excellence: A Strategic Program Guide
Contract Management Best Practices: Tips to Maximize ReimbursementPMMC
Effective contract management systems are critical to maximizing financial performance, minimizing risk, and managing all aspects of payer contracts to get reimbursed accurately.
However, the success of a contract management system is only as strong as your processes. As changes constantly occur – such as government reimbursement methodologies – it’s important to stay ahead of the curve and ensure that your contract management system supports these changes.
In this educational presentation, Kristen Wood, Senior Account Manager - Contract Management at PMMC shares the most pressing issues today related to contract management and how your facility can maximize the use of its contract management vendor.
This presentation covers:
• The impact of registration errors
• Common billing errors (missing modifiers, late charges, etc.)
• Denial monitoring and what to look for
• Upcoming government reimbursement changes (Sequestration, ICD-10, APR-DRG for stat Medicaids) and what to expect
• Managing your A/R days and the importance of reporting
• Payer tactics and how to address them (underpayment trends, silent PPOs, LOS issues)
• False variances and how to conquer calculation challenges
Breaking Down the 2023 Medicare 855 Enrollment Form UpdatesConference Panel
Enrolling with Medicare as a provider or organization can be a challenging and time-consuming task. Despite being the largest insurer in the country, the complexities surrounding enrollment application requirements have resulted in a decline in the number of new Medicare enrollment applications.
The consequences of incorrect submissions can be severe and have systemic implications, such as delays in cash flow, credentialing issues, coding problems, denial management issues, lower patient satisfaction, and even affect quality scores.
In our informative webinar, we will explore the various options available for submitting the 2023 Medicare 855 Enrollment forms, the providers who are eligible for Medicare enrollment, the different form types, and the strategies for navigating the form sections.
We will also delve into key terminology, the ancillary documentation required with enrollment submission, applicable fees, the most common errors, and best practices for completing the CMS 855 forms.
This webinar aims to equip you with the knowledge and tools needed to successfully complete the Medicare enrollment process and avoid potential pitfalls that can have a significant impact on your organization.
Register Now,
https://conferencepanel.com/conference/navigating-the-2023-medicare-855-enrollment-form-updates
When it comes to simplifying the medical credentialing process and optimizing relationships with insurance networks, healthcare providers can benefit greatly from the services of a trusted and experienced credentialing service provider like Instapay Healthcare Services.
Provider Credentialing Steps in Medi-Cal.pptxScottFeldberg
In California, the Provider Enrollment Application is the process by which healthcare providers can enroll in the state’s Medicaid program, known as Medi-Cal. The enrollment process ensures that providers meet the state’s qualifications for participation and establishes a provider’s ability to receive payment for services rendered to Medi-Cal beneficiaries.
Provider Credentialing Steps in Medi-Cal.pdfScottFeldberg
Provider credentialing is a process by which a healthcare provider is verified to ensure they meet the necessary requirements to provide healthcare services to patients. It is important to note that the credentialing process may take several months, so it is best to start the process early.
Provider Credentialing Steps in Medi-Cal.pptxScottFeldberg
Provider credentialing is a process by which a healthcare provider is verified to ensure they meet the necessary requirements to provide healthcare services to patients. It is important to note that the credentialing process may take several months, so it is best to start the process early.
Provider Credentialing Steps in Medi-Cal.pdfScottFeldberg
Provider credentialing is a process by which a healthcare provider is verified to ensure they meet the necessary requirements to provide healthcare services to patients. It is important to note that the credentialing process may take several months, so it is best to start the process early.
Provider Credentialing Process Flow Chart.pdfScottFeldberg
Provider credentialing is a critical process in the healthcare industry, which involves the verification of a healthcare provider’s credentials, qualifications, and experience to ensure they meet certain standards set by the insurance companies.
Provider Credentialing Process Flow Chart.pptxScottFeldberg
Provider credentialing is a critical process in the healthcare industry, which involves the verification of a healthcare provider’s credentials, qualifications, and experience to ensure they meet certain standards set by the insurance companies
Top 10 Medical Billing KPIs That Show Where Your Practice is Losing MoneyKareo
Kareo’s Billing Subject Matter Expert, Terri Joy, MBA, CPC, CGSC, COC, CPC-I, shares the 10 medical billing KPIs you need to know to prevent your practice from losing money.
Practical Solutions for Managing the Coverage Gap Discount Program Paragon Solutions
Since the inception of the Coverage Gap Discount Program (CGDP), Manufacturers have been presented with challenges in managing the CGDP. There are operational, financial, compliance and legal challenges that fall across the organization.
This webcast will highlight those challenges and provide insight into practical solutions Manufacturers have employed to help mitigate these challenges.
What you can expect to learn from the webcast:
- High-Level Process Requirements needed to efficiently manage CGDP
- Practical Solutions that have been applied to mitigate challenges and risks
- How to manage the Negative Balance Solution
- Tips for preparing for the Dispute Resolution Process
- How to maximize data for Financial Analytics
Similar to Provider Enrollment Excellence: A Strategic Program Guide (20)
Medicare and Medicaid Managed Care Enrollments in 2024Conference Panel
The process of enrolling with Medicare and Medicaid Managed Care as a provider/organization can be incredibly tedious and time-consuming. The number of new Medicare and Medicaid enrollment applications continues to decline due to the enormous complexities surrounding enrollment application requirements. The cost of getting these enrollment application submissions wrong can have systemic consequences on an organization, including cash flow delays, credentialing issues, coding issues, claims backlogs, denial management issues, patient satisfaction, and even impact quality scores.
In 2024, Medicare opened the enrollment gates for new mental health providers (MFTs and MHCs) that had previously been excluded from providing services to Medicare beneficiaries. In today's webinar, we discuss the submission options, which providers are eligible for Medicare and Medicaid enrollment, each enrollment type, how to navigate the enrollment process, key terminology, what ancillary documentation is needed with enrollment submission, applicable fees, linkage issues with PTAN numbers, most common errors, and best practice tips for successfully completing the Medicare and Medicaid enrollments in 2024.
Learning Objectives
Understand the CMS 855 enrollment submission process for 2024.
Recall CMS 855A, 855B, and 855I Application requirements for 2024.
Recall the most complicated sections on the 855 applications for 2024.
Recall strategies to complete 855 forms accurately for 2024.
Recall ancillary documentation required with 855 enrollment submissions for 2024.
Avoid common rejections and errors with 855 form submissions.
Recall best practice tips for 855 form submissions for 2024.
Areas Covered
Dissect the various Medicare and Medicaid enrollment types in 2024.
Outline a sample workflow for completing Medicare enrollment.
Outline a sample workflow for completing Medicaid Managed Care enrollment.
Review enrollment forms for Medicare and Medicaid.
Discuss the most challenging Medicare and Medicaid enrollment sections for 2024.
Discuss strategies to complete the Medicare and Medicaid enrollment forms accurately for 2024.
Review the process of reassigning Medicare benefits to organizations for 2024.
Review the ancillary documentation required with Medicare and Medicaid enrollment submission for 2024.
Discuss the most common rejections and errors with Medicare and Medicaid enrollment form submissions for 2024
Register Now,
https://conferencepanel.com/conference/medicare-and-medicaid-managed-care-enrollments
Dispelling HIPAA Myths: Texting, Emailing, and BYOD Best PracticesConference Panel
This 90-minute webinar will detail your practice (or business) information technology and how it relates to the HIPAA/HITECH Security Rule and securing PHI in transmission – what is required and what is myth… I will review multiple examples and specific scenarios and offer simple, common-sense solutions. I will also discuss the do's and don'ts relating to encryption and updated bulletins provided by the Office for Civil Rights.
Areas covered will be texting, email, encryption, medical messaging, voice data, personal devices, and risk factors.
I will uncover myths versus reality as they relate to this enigmatic law based on over 1000 risk assessments performed and years of experience in dealing directly with the Office for Civil Rights HIPAA auditors.
I will speak on specific experiences from over 18 years of experience working as an outsourced compliance auditor and expert witness on multiple HIPAA cases in state law and thoroughly explain how patients can now get cash remedies for wrongful disclosures of private health information.
More importantly, I will show you how to limit those risks by taking proactive steps and utilizing best practices.
Don't always believe what you read online about HIPAA, especially regarding encryption and IT; many groups sell more than necessary.
Register Now,
https://conferencepanel.com/conference/2024-hipaa-texting-and-emailing-dos-and-donts
Medical Record Chapter: Meeting the CMS Hospital CoPs and Access RequirementsConference Panel
This program will cover the CMS regulations and interpretive guidelines for medical records for acute and critical access hospitals in detail. There will also be a brief discussion of the Interoperability and Patient Access Rules. The law affects healthcare providers and effectively grants patients immediate access to health information in their electronic medical records – without charge. Certain records are excluded, and the rule establishes exceptions to “information blocking’. This rule and its implications for healthcare providers will be discussed.
This program will revisit information on HIPAA from the Office of Civil Rights, including the difference between patient access versus when authorization is needed. There will also be a discussion on The Joint Commission, which changed many of its standards to comply with the CMS CoP requirements.
Other topics to be discussed include the security of health information and OCR Security Risk Assessment.
Learning Objectives
Recall that CMS has specific informed consent requirements.
Describe when a history and physical must be done and what is required by CMS.
Explain both CMS and The Joint Commission standards on verbal orders.
Recall that CMS has standards for preprinted orders, standing orders, and protocols.
Describe when and circumstances by which healthcare providers can “block” patients/others' access to health information.
Register Now,
https://conferencepanel.com/conference/medical-record-chapter-meeting-the-cms-hospital-cops-and-access-requirements
Grievances and Complaints 2024 Compliance with the CMS CoPs, Joint Commission...Conference Panel
Hospitals receiving Medicare or Medicaid reimbursements must adhere to CMS Conditions of Participation, with grievance requirements often cited for deficiencies. While acute hospitals have specific grievance standards outlined in the patient rights section, Critical Access Hospitals (CAHs) must also establish policies to address patient grievances.
Exploring Section 1557 of the Affordable Care Act, enforced by the Office of Civil Rights, hospitals are mandated to have grievance procedures to investigate alleged noncompliance, including discrimination.
This program delves into Joint Commission standards on complaints and DNV Healthcare's grievance standards, intersecting with CMS guidelines. Staff education and adherence to hospital grievance policies, board approval, and comprehensive documentation in medical records are essential.
Register Now,
https://conferencepanel.com/conference/grievances-and-complaints-2024
The 2024 Prior Authorization Process For Medical ProvidersConference Panel
Prior Authorizations are a cost containment strategy that third-party payers leverage to control costs, restrict patient access to services, testing, and medications, and ultimately discourage medical providers from ordering unnecessary medical treatment. Prior authorizations are a major source of headaches for healthcare providers nationwide. Despite the intention to control costs and ensure appropriate care, the prior authorization process has been criticized for its enormous administrative burden, potential delays in necessary medical treatment, and added complexity for healthcare providers.
Striking a balance between cost control and efficient patient care remains a major challenge in the healthcare industry. Join us for an insightful 60-minute webinar as we take a deep dive into the complexities of the Prior Authorization process, discuss the pearls and pitfalls, define medical necessity requirements, and demystify the intricacies of obtaining prior authorizations, ensuring a smoother workflow and higher approval outcomes in 2024.
Learning Objectives
Understand the major Prior Authorization Updates for 2024.
Recall medical necessity and its critical role in the Prior Authorization approval process.
Identify which insurance payers require Prior Authorizations in 2024.
Recall methods for obtaining Prior Authorizations in 2024.
Recognize common challenges experienced when obtaining Prior Authorizations.
Understand how to escalate and appeal Prior Authorization denials in 2024.
Areas Covered
Discuss the major Prior Authorization Updates for 2024.
Explore the 2024 Prior Authorization requirements for Medicare Advantage Plans.
Define medical necessity and its critical role in the Prior Authorization approval process.
Explore the regulatory landscape for Prior Authorizations in 2024.
Identify which insurance payers require Prior Authorizations in 2024.
Discuss methods for obtaining Prior Authorizations in 2024.
Review common challenges experienced when obtaining Prior Authorizations.
Outline successful strategies to overcome challenges with obtaining Prior Authorizations in 2024.
Discuss how to escalate and appeal Prior Authorization denials in 2024.
Share best practice compliance tips for Prior Authorizations in 2024.
Register Now,
https://conferencepanel.com/conference/mastering-the-2024-prior-authorization-process-for-medical-providers
Protecting Patient Privacy: Navigating HIPAA in Digital LandscapesConference Panel
Learn how to safeguard your healthcare practice from unintentional HIPAA violations in online marketing. Discover simple steps to ensure compliance with HIPAA Privacy Rule while effectively engaging patients online. Join our webinar to understand the risks of using visible and invisible tracking technologies and how to mitigate them. Stay competitive in the digital marketplace without compromising patient privacy. Don't miss out on essential administrative safeguards to protect your organization from liability. Register now for actionable insights!
What You'll Learn?
Website HIPAA Compliance
New Prohibition of Tracking Technologies (Meta Pixel, Google Analytics)
Social Media HIPAA compliance
Facebook – common violations - Terms of Use – Prohibited
Facebook Terms of Use and Posts Prohibited by Facebook
How to use Facebook in compliance with HIPAA and Facebook’s Terms
Reviews by patients posted on Internet platforms
What you may do
What you must not do
This webinar explains HIPAA Compliance Safeguards allowing Health Care Providers to do effective Internet-based marketing and comply with HIPAA.
Register Now,
https://conferencepanel.com/conference/new-hipaa-compliance-for-web-sites-tracking-technologies-social-media-patient-reviews
HIPAA Guidelines and Electronic Communication: What Healthcare Professionals ...Conference Panel
Learn how HIPAA privacy rules permit healthcare providers to communicate electronically with patients and colleagues while maintaining confidentiality. Discover the precautions needed, such as verifying email addresses and limiting information in unencrypted emails. Patients have rights to request alternative communication methods, and healthcare providers must accommodate reasonable requests. Find out how to navigate state licensure laws for additional confidentiality measures. Gain clarity on patient consent and communication practices for electronic communication in healthcare.
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https://conferencepanel.com/conference/emailing-texting-use-of-personal-devices-by-healthcare-professionals
Nursing Standards in Hospital Accreditation: CMS Guidelines 2024Conference Panel
Ensure your hospital's nursing services comply with CMS Conditions of Participation (CoPs) to maintain Medicare and Medicaid reimbursement eligibility. Join our webinar as we delve into crucial aspects of the CoP manual, including plans of care, staffing requirements, policy changes for outpatient departments, documentation standards, supervision protocols, nursing leadership expectations, and more.
Discover the latest updates and anticipated interpretive guidelines for the nursing chapter of the CoPs, addressing areas frequently cited in compliance assessments. With nursing services cited over 8,900 times in recent reports, understanding these regulations is paramount.
We'll also explore past changes in nursing regulations, such as medication timing, standing orders, blood transfusions, IV medication administration, self-medication protocols, and drug order procedures. Stay informed about evolving non-discrimination regulations under Section 1557 and other manual sections affecting nursing practices.
Don't miss this opportunity to ensure your hospital's nursing services meet regulatory standards and optimize patient care. Register now to stay ahead of compliance requirements and enhance your facility's operations.
Register,
https://conferencepanel.com/conference/nursing-standards-cms-condition-of-participation-for-hospitals
Implementing CMS Hospital QAPI Guidelines for 2024Conference Panel
Explore the significance of Quality Assessment and Performance Improvement (QAPI) programs in Medicare-certified hospitals, focusing on the updated CMS standards and interpretive guidelines. Learn about essential requirements, assessment areas, and hospital leadership's role in ensuring compliance and enhancing patient safety.
Title: Understanding CMS Hospital QAPI Standards and Guidelines: Key Elements for Implementation and Compliance
Description: Explore the significance of Quality Assessment and Performance Improvement (QAPI) programs in Medicare-certified hospitals, focusing on the updated CMS standards and interpretive guidelines. Learn about essential requirements, areas of assessment, and the role of hospital leadership in ensuring compliance and enhancing patient safety.
Quality Assessment and Performance Improvement (QAPI) Conditions of Participation deficiencies rank among the top three cited issues for Medicare-certified hospitals, highlighting the critical need for robust QAPI programs. CMS emphasizes the pivotal role of well-designed and maintained QAPI initiatives in enhancing patient care quality, reducing medical errors, and fostering a safer healthcare environment.
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https://conferencepanel.com/conference/cms-hospital-qapi-standards-2024
Demystifying Shared Care and "Incident To" Billing: 2024 UpdatesConference Panel
This webinar aims to elucidate the changes for the year 2024 concerning billing for shared and incident care services. Furthermore, it will delineate the requisite documentation requirements essential for both shared and incident care billing scenarios.
By attending this webinar, healthcare providers can gain a comprehensive understanding of the evolving CMS policies and the intricacies of billing for shared and incident care. Armed with this knowledge, they can adopt proper billing practices and uphold the requisite documentation standards, thereby minimizing the risk of audits, paybacks, and reimbursement delays.
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https://conferencepanel.com/conference/secrets-to-correctly-billing-shared-care-and-incident-to-services-in-2024
Ensure smooth reimbursement by staying informed on "CPT Code Changes for 2024." Provider responsibility is paramount, given limited insurer education on annual updates. Office staff should comprehend procedures, documentation for compliance, and insurer policies on medical necessity, prior authorization, and coverage. The presentation will elucidate the 2024 highlights, empowering attendees to adeptly apply changes adeptly, mitigating delayed or denied claims, and preserving office cash flow.
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https://conferencepanel.com/conference/cpt-changes-2024
Breaking Down the Latest HIPAA Modifications: What's New in 2024 and BeyondConference Panel
This advanced webinar on HIPAA Changes for 2024 delves into the intricate federal regulatory process of notice and comment rulemaking, highlighting the considerable authority granted to federal agencies like the HHS in shaping new regulations.
The webinar delves into responding to security incidents using lessons learned from recent HHS sanctioning cases, emphasizing cybersecurity sanction policies as a means to enforce HIPAA compliance. The session concludes with valuable tips and techniques to anticipate and navigate HIPAA changes in 2024, offering insights to minimize risk and liability. The discussion begins by addressing the 2023 proposed changes to HIPAA exploring the reasons for their extension into 2024.
Decoding the Latest Changes in the 2024 Medicare Physician Fee Schedule (MPFS...Conference Panel
The 2024 Medicare Physician Fee Schedule (MPFS) Final Rule introduces extensive changes, including substantial cuts to the 2024 conversion factor, updates to the Medicare Economic Index, and significant alterations to Evaluation and Management (E/M) services. The revisions extend to code valuations and various quality reporting programs. Faced with record-breaking inflation, physician and provider organizations are expressing outrage and advocating for urgent congressional action and payment reform. In response, a webinar has been organized to thoroughly dissect these updates, offering healthcare professionals actionable insights to navigate the complexities effectively. The session aims to empower participants with tangible information that can be immediately applied in response to the unprecedented changes in the healthcare landscape.
Register,
https://conferencepanel.com/conference/navigating-the-2024-medicare-physician-fee-schedule-mpfs-final-rule-updates
What Physicians Need to Know: CMS Final Rules 2024Conference Panel
The CMS proposed rule for physician payment and coding changes sets the tone for the upcoming year. Attending this update ensures you are well-informed about the latest regulatory changes affecting healthcare services. Understanding the modifications proposed by CMS allows providers to adapt their coding practices, ensuring accurate reimbursement for the services they provide.
Knowledge of issues that were not implemented for 2023 provides valuable insights into what CMS is considering for the following year. This foresight enables strategic planning for 2024, allowing healthcare professionals to anticipate and prepare for potential changes. This year's update promises significant changes to key areas such as EM services, splits/shared care, remote patient monitoring (RPM), and complex chronic care management (CCM).
Register,
https://conferencepanel.com/conference/cms-physician-final-rules-for-2024-find-out-what-cms-has-finalized-from-the-proposed-rules
A Deep Dive into 2023: Hospital CoPs and Best Practices for History and Physi...Conference Panel
We are excited to invite you to an informative webinar that will address recent changes in CMS regulations concerning History and Physicals (H&P) for healthy outpatients. The evolving landscape of healthcare policies requires hospitals to stay abreast of alterations in guidelines to ensure compliance.
Why Attend:
Stay informed about recent changes in CMS regulations.
Learn how to develop a comprehensive policy addressing H&P requirements.
Ensure compliance with The Joint Commission and DNV standards.
Gain insights into common deficiencies and strategies for improvement.
Please register for the webinar to secure your spot. We look forward to your participation in this essential webinar that will equip your hospital with the knowledge and tools needed to navigate the evolving landscape of History and Physical requirements.
Register,
https://conferencepanel.com/conference/history-and-physicals-meeting-hospital-cops-in-2023
Demystifying the 2024 OIG Audit Selection CriteriaConference Panel
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https://conferencepanel.com/conference/navigating-the-2024-oig-audit-targets
CMS Preventive Services for Medicare Patients refers to the Centers for Medicare & Medicaid Services (CMS) programs that provide preventive healthcare services to Medicare beneficiaries. These services are designed to detect and address health issues early, helping seniors maintain their well-being and potentially reducing healthcare costs in the long run. Preventive services covered by Medicare may include vaccinations, screenings, annual wellness visits, and counseling on various health-related topics. These services are essential for promoting the health and longevity of Medicare patients while preventing more serious and costly medical conditions.
The webinar is designed to provide information and guidance to healthcare providers and professionals on preventive services covered by Medicare for their patients. These services are aimed at helping Medicare patients maintain and improve their health by identifying and preventing illnesses or conditions. The webinar likely covers topics such as eligibility, coding, billing, and updates on preventive services guidelines for Medicare beneficiaries. It is a resource to keep healthcare providers updated on Medicare's preventive care offerings.
Register,
https://conferencepanel.com/conference/cms-preventive-services-medicare-patients
Part B Unpacking the 2023 CMS Hospital Infection Prevention MandatesConference Panel
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"CMS" stands for the Centers for Medicare & Medicaid Services, a federal agency that administers various healthcare programs and sets compliance standards for healthcare providers.
"Hospital Infection Prevention & Control" pertains to measures and protocols aimed at preventing and controlling the spread of infections within hospital settings.
"Part B" likely indicates a specific section or aspect of the compliance guidelines for infection prevention and control in hospitals.
This topic suggests that healthcare providers, particularly hospitals, need to navigate and comply with the updated regulations and guidelines related to infection prevention and control set forth by CMS in 2023. Compliance is crucial for ensuring patient safety and maintaining eligibility for Medicare and Medicaid reimbursements.
Register,
https://conferencepanel.com/conference/the-cms-hospital-infection-prevention-and-control-and-antibiotic-stewardship-program-cms-compliance-requirements-2023
Part A Unpacking the 2023 CMS Hospital Infection Prevention MandatesConference Panel
The CMS Hospital Infection Prevention and Control program is a vital initiative for healthcare facilities to ensure patient safety and reduce the spread of infections. In 2023, CMS compliance requirements for this program emphasize the need for hospitals to implement rigorous infection control measures, maintain stringent hygiene standards, and promote antibiotic stewardship to prevent the emergence of antibiotic-resistant strains of bacteria. Hospitals must adhere to these requirements to maintain their CMS certification and provide high-quality, safe patient care.
Learning Objectives:-
Recall the standard and new interpretive guidelines for infection prevention and control
Relate key requirements for an infection prevention and control program
Identify the requirements for infection prevention and Antibiotic Stewardship lead
Describe what CMS requires for safe injection practices and sharps safety
Discuss that CMS has a final infection control worksheet
Register,
https://conferencepanel.com/conference/the-cms-hospital-infection-prevention-and-control-and-antibiotic-stewardship-program-cms-compliance-requirements-2023
Key Elements of CMS Emergency Preparedness RegulationsConference Panel
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Healthcare organizations must meet both CMS and TJC requirements to ensure compliance with federal regulations and maintain accreditation. These requirements are designed to enhance patient safety and the ability of healthcare facilities to respond effectively to emergencies, including natural disasters, infectious disease outbreaks, and other crises. Regular updates and revisions to these requirements may occur, so healthcare providers need to stay informed and adapt their emergency preparedness programs accordingly.
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https://conferencepanel.com/conference/cms-regulatory-requirements-for-emergency-preparedness-programs-and-tjc-compliance
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
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Provider Enrollment Excellence: A Strategic Program Guide
1. A Guide to Provider Enrollment
Building a Successful Provider Enrollment Program
A Webinar Presented By
Cati Harris, CBCS, CCS, CPCS
Director of Provider Credentialing -Solor, Inc
2. Cati Harris, CBCS, CPCS
Director of Provider Credentialing &Contracting Solor,Inc.
Professional Experience:
● Over 20 years experience in Medical Billing,Coding, Provider
Credentialing/Contracting
● 15 years clinical experience
● Currently provide credentialing services for 2 major hospital systems, and
14 private practices(35+physicians/PA/NP)
Educational Experience:
● Diploma withHonors inMedical Billing&Coding
● Certified Billing and Coding Specialist
● Certified Provider Credentialing Specialist
● Certified Credentialing Specialist
3. Learning Objectives
Welcome to the Webinar!
This webinar was developed to provide you with information on building
your credentialing program with focus on the preparation, verification,
submission, and completion of the provider credentialing process.
● When to Start Credentialing
● Setup and Maintenance of NPPES, I&A Management System, CAQH, PECOS
● How to review, validate, and track provider documents
● How to Prepare, Review, Submit, and Track Payer applications
● Items to complete once the provider is credentialed/contracted
● Linking of a previously credentialed provider with payers to your tax id/contracts
● Brief overview of Provider Revalidations
4. Keys to Success in Credentialing
● Research
● Preparation
● Tracking
● Communication
5. RESEARCH
Research is the key to SUCCESSFUL Provider Credentialing
The research process is divided into two parts:
● Provider Research
● Payer Research
6. First Step -Provider Research Questions
● What is the providers anticipated start date?
● Is the provider newly licensed?
● State Approved Medical License
● Does the provider have a registered NPI?
● Has the provider been previously credentialed with payers?
● Does the provider have any disciplinary actions, previous
criminal charges, or malpractice claims?
● Mid-Level - Is the supervising md approved?
● Mid-Level - Is the collaborative agreement signed?
7.
8. Research -Payer
● Payer Application and Document Requirements
○ Copy of Application and Applicable Forms
○ Online Payer Application Location
○ Payer Estimated Processing Time
○ Payer Preferred Submission Method
● Payer Contact Information
○ Website, Email, Phone, Fax
● Payer Provider Representative Contact Information
9.
10. Provider Document Preparation
● Review All Documents for Accuracy, Dates, Infractions
○ Verify Licensure and Board Certifications are current with no infractions -Explain previous disciplinary
actions
○ Verify Malpractice Insurance is for current group and review for previous claims
■ Previous Malpractice Claims -Provider must provide detailed information/explanation
○ Verify DEA License is Current without restriction
○ Verify Provider Education, Residency, Fellowship etc.
● Create a Provider File
○ This file will contain all original documents.
■ It is suggested to save a copy of the originals in a secure location on your computer.
■ Organization of the Provider File (Two Sided Folder)
● Access Provider Logins
○ CAQH, PECOS, I&A, NPPES (I/A, PECOS -Prefer Surrogate Access)
○ Attest CAQH every 60 days (120 days is requirement)
11. ● NPPES -https://nppes.cms.hhs.gov/#/
○ Obtain Login/PW or Setup access (The login for the I&A System is the same for NPPES)
○ Verify Provider Information
■ Correspondence Address and Practice Address
■ Provider Contact Information
■ Phone number, Email
■ Taxonomy
■ Delegated Access
■ Provider ID#’s
● NPPES Must be current and approved before proceeding with any provider
credentialing.
● Print out any update confirmations completed
NPPES
12. ● CAQH -https://proview.caqh.org/Login/Index?ReturnUrl=%2f
○ Obtain Login/PW or Setup access
○ Review/Complete each section
○ Add your information in the credentialing contact
○ Add your email on the provider info page as a secondary contact
○ Ensure the Authorization Section is Checked to Allow all Payer Access
○ Upload the following documents
■ Attestation
■ Certificate of Insurance
■ State License
■ DEA
■ Provider CV
■ Board Certification
■ Med School Degree including any Residency or Fellowship Cert
CAQH
13. ● PECOS -https://pecos.cms.hhs.gov/pecos/login.do#headingLv1
○ The login for PECOS is the same username and password used for I&A Management System
■ Prefer Access via Surrogate
○ Select My Associates
■ Scroll to bottom and check for current enrollments
● If provider is currently enrolled, check to see if the provider is enrolled with the correct
state and MAC.
■ If provider is not enrolled, you will select to start the process.
● Complete all tabs, run an error check, locate name of group authorized signatory for
the reassignment of benefits
● Once error check shows no errors, you can complete submission
○ Be sure to print out copy of application and submission
○ You will receive email confirmation
■ Re-Validations
● Select revalidation notification center instead of “My Associates”
PECOS
14. Application Preparation
Completion of the payer application with current and accurate information is critical to the
provider enrollment process.
Errors on the application or within the application package can result in holds or
rejections
● Complete all fields on application. Do not leave any blanks.
○ If the information does not apply enter N/A in the space.
○ Do not write to refer to another document in the space.
● Review document a min of 2 times
○ Once doing a forward review
○ Once doing a reverse review
15. Linking a Provider already PAR with the PAYER
If the Provider is already credentialed/contracted with the payer as a participating
(PAR) provider, you will need to complete a link to your TAX ID and group contract.
To Complete a link:
● Complete the Provider Link Letter
○ Include the Tax ID, Group NPI, Practice Address, Phone, Fax
○ Include the provider/mid-levels Name, Individual NPI
○ Include the effective date of the link
○ Include a current W9 for the group
● Once you have completed the above information, you will submit the link letter via the preferred
method for the payer. Most payers have a specific email or fax they want the request submitted to.
Make a call to the payer to ensure the specific method of transmission of the link letter.
● Exception: Medicare/Medicaid -For Medicare you will complete the reassignment of benefits in
PECOS by submitting a change of information application under the current enrollment. Medicaid
varies by state, contact your local Medicaid enrollment office for directions
16. Provider Re-Validation
All Payers require re-credentialing/re-validation once the provider is credentialed.
Important Information Regarding Provider Re-Validations/Re-Credentialing:
● When the provider is initially credentialed, inquire with payer when the re-credentialing will
be due.
○ Most payers are either every 3 years or Every 5 years
● Maintain a database or spreadsheet for each provider with the payers re-validation dates
listed.
● At least 60 days prior to re-validation due date, inquire with the payer the requirements for
the providers re-validation
● Ensure CAQH is up to date and attested prior to inquiring or beginning re-validations.
● PECOS aka Medicare Re-validations are every 5 years
○ Select revalidation notification center instead of “My Associates” within PECOS to
obtain due date of re-validation and to complete the process.
17. Termination of a Provider
In the course of business, there may come a time in which a provider is terminated
from your practice, whether it be voluntary or involuntary. When this takes place,
there are steps you need to complete as the group to ensure the provider is no
longer linked to your tax id and group contract with the payer.
● Prepare the Letter Requesting a Provider Termination.
○ Include the Tax ID, Group NPI, Practice Address, Phone, Fax
○ Include the provider/mid-levels Name, Individual NPI
○ Include the effective date of the termination
○ Include specific language that requests the provider be removed from your group contract and
unlinked from your Tax ID with the payer.
● After you submit the letter, follow up within 72 hours of submission to ensure receipt and processing
of the termination.
● Exception: Medicare/Medicaid -This will be done in the provider’s PECOS by removing the
reassignment of benefits to your practice and updating the contact information. This can be done by
the provider. Request proof of completion and approval from the provider. For Medicaid, contact
Medicaid for yoru state directly and follow the process.
18. Tracking
Provider Enrollment Tracking is the foremost action to
ensure timely, efficient submission and processing of
the provider enrollment application package.
Lack of tracking can lead to:
● Payer misplacing application package
● Delayed application submission and processing
● Missed request for more information, missing
documentation
● Application being Red Flagged by Payer
● Financial loss and increased credentialing costs
20. Communication
Communication is the key to successful and
timely processing of your providers
credentialingapplication.
Keystosuccessfulcommunication:
● Consistent updatesprovidedto the
providerandappropriate
administrative staff vialive google doc
linksand/orEmails
● Consistent trackingandfollow upon the
statusofthesubmittedpayer
applications.
● Trackingthepayerprovided
estimated processing times.
● Updating/MaintainingTracking Tools
21. Stepsto Minimize Financial Impact
● Begin the credentialing process a minimum of 60 days before provider
anticipated start date. Preferably 90 days.
● Maintain CAQH and attest every 120 days
● Ensure I&A, NPPES login stay up to date with accurate information.
● Consistently follow up with payers to ensure timely processing.
● Organize and maintain all provider data, documents, and applications. Update
frequently.
● Timely Provider and administrative staff credentialing status updates.
● Maintain Live Update Document (Google Sheet, One Drive, MS Teams, Etc)
● Maintain tracking spreadsheet for provider payer applications submissions
and updates.
● For Mid-Levels - Research billing Incident Too
22. Provider CredentialingisApproved…..
What isnext?
● Request copy of approval/welcome letter from payer
● Request payer specific provider #
● Inquire when the revalidation will be due
● Request copy of contract and fee schedule
○ Review both the contract and fee schedule prior to signing
○ Once signed, request copy of signed contract
● Create Master Information Sheet with payer specific information
○ Credentialing effective date
○ Payer Specific Provider #
○ Contract Effective Date
○ Fee Schedule Effective Date
23. Once you have the requested payer approval information,
you will need to store a physical and digital copy.
● Create a Provider Binder
○ Section for each Provider
■ Within Each Provider Sections, Organize by Payer
● Payer Section includes:
○ Provider Information Sheet
○ Payer Welcome/Approval Letter
○ Effective Date, Revalidation Date
○ Payer Specific Provider #
○ Copy of Contract/Fee Schedule
○ Original Submission Package
Information Storage
24. Included with this webinar are several forms mentioned throughout the presentation
● Credentialing Description of Services
● Provider Enrollment Information, CV Requirements, Document Checklist
● CAQH Attestation Form
● Cover Letter, Fax Cover Letter for Payer Application Submissions
● Cover Letter, Fax Cover Letter, and Provider Link Letter
● Verification of Licensure/Certification/Education Form
● Tracking Spreadsheet
● Payer Application Information Form
● Termination Letter
If you did not receive the forms with this presentation, please reach out to me via
email: cballard@mysolor.com
Forms
25. Are you in need of an experienced
credentialing professional?
If you answered “YES”, please contact
me to arrange your FREE consultation
for credentialing services.
Mention Code: WEBINAR to Receive a discount on
contracted services!
Cati Harris, CBCS,
Director of Provider Credentialing
Solor, Inc
Phone 704-675-7279
Email: cballard@mysolor.com
26. Cati Harris, CBCS,
Director of Provider Credentialing
Solor, Inc
Phone 704-675-7279
Email: cballard@mysolor.com
Thank you for your time and
attendance!
Questions?
Register Now