Part 1 - Credentialing Foundations: Navigating Medicare Enrollment for Providers
Title: Medicare Provider Enrollment 101: Complete Enrollment and Credentialing Process for Providers
Overview:-
This session guides healthcare professionals through the complexities of Medicare provider enrollment, credentialing, and revalidation. It explains CMS-855 forms and emphasizes credentialing's role in the revenue cycle.
Learning Objectives:-
Gain an overview of CMS connections necessary for compliant Medicare provider applications.
- Understand the distinctions between Part A facility applications and Part B organization and individual applications.
- Learn about reassignment applications and the revalidation process for various CMS-855 forms.
- Review each section of the application within the PECOS system.
- Familiarize with payer-specific rules and requirements for both government and commercial payers.
Topics Covered:-
- Credentialing & Enrollment
- Joining the Network
- First Action Steps (I&A, NPI, NPPES, CAQH, Fee Schedules)
- Portals & Profiles
- Delegated vs. Non-Delegated Credentialing
- Building a Credentialing Database
- CMS & Availity Connections
Who Should Attend:-
Credentialing Specialists, Revenue Cycle Managers, Enrollment Specialists, Hospital Administrators, Mental Health Professionals
Part 2 - Credentialing in Practice: Document Management and Payer Applications
Title: Credentialing and Provider Enrollment 102
Overview:-
A deeper dive into credentialing and provider enrollment. Includes document handling, payer communications, system setup, and customizable tools.
Topics Covered:-
- Provider Documentation Requirements
- Verification and Validation
- Document Tracking
- System Maintenance (CAQH, PECOS, NPPES, I&A)
- Payer Applications (Medicare, Medicaid)
- Communication Strategies
- Post-Approval Steps
- Tools Provided: Printable/customizable forms and tracking tools
Learning Objectives:-
- Understand setup and maintenance of systems like CAQH, PECOS, NPPES, I&A.
- Learn full payer enrollment process.
- Gain knowledge of payer requirements and submissions.
- Develop skills to track applications effectively.
Who Should Attend:-
Practice Managers, Credentialing Specialists (PESC, CPMSM), Revenue Cycle Directors, CFOs, and related professionals.
Part 3 - Advanced Credentialing: Mastering NPPES, PECOS, and CMS I&A Accounts
Title: Credentialing and Provider Enrollment 103
Overview:-
Advanced strategies for managing multiple systems and payer enrollments, with a focus on CMS platforms and surrogacy account management.
Topics Covered:-
- CMS I&A System Setup
- NPPES Management
- Payer Enrollment Applications
- Application Tracking
- Surrogacy Program Utilization
Learning Objectives:-
- Set up, maintain, and attest NPPES and I&A accounts.
- Complete payer applications accurately.
- Navigate payer-specific requirements.
- Track enrollment effectively.
- Manage multiple NPI profiles.
Who Should Attend:-
Practice Managers, Credentialing Specialists (PESC, CPMSM), Revenue Cycle Directors, CFOs, and those involved in provider enrollment and EFT operations.
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Yesenia Servin CPMSM, PESC is an expert in credentialing and provider/payer enrollment with over 23 years of experience in the healthcare industry. Yesenia has a deep understanding of Medicare & Medicaid enrollment and is a nationally certified credentialing manager and provider enrollment specialist. Through, YS Credentialing PLLC, Yesenia helps organizations develop and implement best practices guidelines, and processes. Guides the credentialing and payer enrollment structure. Thrives on training and growing administrative, credentialing, and enrollment healthcare professionals.
Yesenia manages payer enrollment, keeps team members and colleagues up to date on industry trends, and is a liaison to all departments that impact payer-enrollment processes. Yesenia works with durable medical equipment, hospitals and health systems, and community mental health organizations, global managed care organizations as well as providing revenue cycle consulting services to various healthcare providers and organizations.
Yesenia is a current CharterOak University Faculty, a NAMSS member, and is a past NAMSS Educational Conference Guest Speaker, a current member of the NAHRI Leadership Council, a current trainer for The Chicago School of Professional Psychology trainer, and a TMG Collaborator. Yesenia studied microeconomics and communications at NEIU and healthcare administration at Concordia University Chicago.
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