Basic Provider Enrollment — Two-Part Virtual Series

Details

Each session will be held from 10 to 11:30 a.m.

• Tuesday, May 10 — Part I
• Tuesday, May 17 — Part II

Audience

medical service staff professionals, credentialing specialists, medical directors, vice president of medical affairs, quality improvement professionals, medical staff leaders, credentials committee members, and anyone involved with the credentialing and privileging functions

Overview

Negative impacts to bottom-line revenue continue to increase for hospitals, medical practices and other health care organizations. One contributing factor is the misconception that anyone can perform the tasks of provider enrollment with health insurance plans. Now more than ever, the importance of understanding basic provider enrollment is essential to prevent lost revenue. How? Educate your team on the basic aspects of provider/payer enrollment, including the definition of key terminology, identifying the difference between in- and out-of-network providers, timely follow-up, and how enrollment can impact bottom-line revenue.

This series will discuss the "No Surprise Act." It also focuses on the benefits of payer credentialing, identifying and overcoming bottlenecks, and challenges in the provider/payer enrollment process. Participants will be provided a sample payer matrix tool for mapping their provider enrollment process to create overall efficiency, as well as learn the key to building relationships with payer representatives.

Objectives

At the conclusion of this session, participants will be able to:

• • describe the steps in the provider enrollment process and the importance of timely follow-up with payers
  • define and identify common payer enrollment, contracting and credentialing terms
  • explain the importance of the "No Surprise Act"
  • identify and explain bottlenecks and challenges related to provider enrollment and payer credentialing
  • describe the methodology to create a payer matrix tool
  • explain the importance of effective communication with payer representatives

Speaker

Merella Schandl is the President of G&G Schandl Consulting and has 29 years of health care experience having worked with all facets of the industry. She also is the senior operations and leadership advisor with Anders CPAs + Advisors in St. Louis.

Schandl advises hospitals, managed care organizations and physicians on regulatory compliance, credentialing and provider enrollment. Schandl designs and implements plans for integrating hospital medical staff offices and provider enrollment to enhance revenue cycles. She provides practice assessments to independent/group physicians/hospitals, identifying areas of deficiency or duplication related to process improvement, design flow, staffing and other processes. She helps facilitate new practice start-ups and/or closures. Schandl recently retired as a National Association of Medical Staff Services Instructor, where she developed educational material and provided industry education to those seeking certification in credentialing and leadership. A frequent presenter, she shares her depth of health care knowledge through local and national speaking opportunities. Schandl holds a master's in health care administration, a bachelor's in workforce development and education, dual certification in Medical Staff Services Management and Credentialing, and is a Lean Six Sigma Greenbelt.

This educational activity is provided by MHA Health Institute.