Compliance with CMS regulations requires the credentialing process to begin with a completed application and attestation to its correctness signed/dated by the practitioner. There are many things to do for accurately keeping track of your provider’s numerous credentialing and enrollment obligations. If something left undone, or if the information is not 100% accurate, they can be denied and left with no way to get paid for the services they provide. Whether you are managing payer credentialing requests, updating hospital applications or adding a new provider, there are a million places where things can go wrong.
We will take a step by step of credentialing do’s and don’ts. There are 10 key steps in the credentialing process to ensure success and prevent costly delays. Learn payer tricks and what to ask to move your credentialing and contracting through the process as smooth as possible. There are so many pieces of information, websites, requirements and confusion when it comes to credentialing a lot of practices just give up and don’t ever get contracted. If you want to be contracted with a payer there is always a way, you just need to organize your data and follow a few key steps to minimize frustration. Also, learn how to appeal a denied application and what things to include with your appeal.
You will learn how to work with payers during the credentialing and contracting phase. The top reasons for denial or credentialing to be suspended/stopped. How to organize all the information and what is needed from providers to begin the credentialing process. We will go over a few of the online websites for credentialing (CAQH, PECOS etc) and review the important parts of these platforms to be sure you enter all pertinent info.
After attending the session, participants will be able to:
- Become aware of how to understand insurance credentialing and contracting, and gain experience of how decipher hidden meanings and tricks up the payers sleeves
- Discover tips and tricks of getting contracts even when out of network prior
- Know top reason for denial
- Follow up of applications with ease as you will learn how to be extra aggressive with payers to get the results you need
- Be familiar with online credentialing websites
- Be comfortable with appealing decisions and proving necessity for in network status.
Areas Covered in the Session:
- Demographics information for providers
- How to credential a group vs single provider
- Importance of valid information (CV, Diplomas, Board Cert, DEA, License etc)
- Online portals for credentialing
- Appealing denied application
- How to organize information
- Proper follow up techniques
- Live Q&A Session
- Medical Assistants
- Claims Processors
- Payment Posters
- Anyone involved with professional fee for service billing and coding
About the Presenter:
Stephanie Thomas, CPC, CANPC, has a widespread background in medical billing, internal audit and health care administration. She is a Certified Professional Coder as well as a Certified Anesthesia and Pain Coder. Stephanie’s combination of clinical experience, coding education and revenue cycle management offer insights that speak well to both the clinician and the revenue cycle expert. Stephanie’s experience includes working in large and small private practices, ambulatory surgery centers as well as with hospital-based physicians. She is responsible for proposing, budgeting, staffing, leading and conducting various compliance and internal reviews. Stephanie is currently a member of the American Academy of Professional Coder’s (AAPC) and Society for Pain Practice Management (SPPM). She speaks nationally on billing and compliance topics regularly and has nearly 20 years of experience in this field.
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