Payor Enrollment: Revenue Cycle Impact, Payors and How to Avoid Delays

Event Materials (Key Required)

Course Description

Payor enrollment is a time-consuming process that creates barriers to practitioner onboarding and revenue generation. Payor enrollment can delay the onboarding process for months, especially with commercial payors. These delays create issues with provider satisfaction, patient satisfaction, revenue generation, access to care and ultimately patient safety.

This presentation will review payor enrollment’s impact on revenue cycle, review the process for enrollment with government and commercial payors, and discuss the most common reasons for delays in payor enrollment and steps to take to avoid those delays. The presenter will go over crucial steps that impact your revenue cycle, including insurance credentialing and contracting and provider enrollment. Providers will understand how to create an efficient enrollment process and understand the connection with a healthy revenue cycle.  

Learning Objectives

• Define payor enrollment and revenue cycle
• Discuss payor enrollment’s impact on revenue cycle
• Review process for enrollment with government and commercial payors
• Discuss most common reasons for delays in payor enrollment and steps to avoid delays
• Review PECOS history and how to enroll providers in PECOS
• In-depth discussion on changes to 855I and 855R applications
• Review new provider types to enroll in Medicare

Areas Covered in the Session

• How does payor enrollment affect revenue cycle
• The importance of payor enrollment
• Differences between government payors and commercial payors
• Steps to enroll providers with government payors
• Steps to enroll providers with commercial payors
• Setting up new providers in NPPES, Identity & Access Management System & PECOS
• Timelines for payer enrollment for government and commercial payers
• How to avoid delays in payer enrollment
• Live Q&A Session

Suggested Attendees

• Payer Enrollment Specialists
• Payer Enrollment Supervisors and Managers
• Practice Administrators
• Credentialing Specialists
• Revenue Cycle Managers
• Physician Practices
• Central Verification Office Supervisors and Managers
• Medical Staff Coordinators
• Medical Staff Managers
• Medical Billing Companies
• Providers Office Staff
• Insurance Companies
• Healthcare Attorneys
• Compliance Officers
• Authorizations Staff
• Practice Managers
• Authorized officials
• Delegated officials
• Office Manager

About the Presenter

Tammy West, MHA/ED, CPMSM, CPCS, is Director Professional Services for The Hardenbergh Group. She brings  25 years of experience in healthcare administration and 16 years in Medical Staff Services. Tammy specializes in CVO operations, provider credentialing, provider enrollment, quality analysis, quality improvement, quality auditing, delegation audits, and policy and procedure creation and implementation. She has extensive experience with CMS, TJC and NCQA requirements for provider credentialing and medical staff services.

Prior to joining The Hardenbergh Group, Tammy was a consultant and independent contractor for hospitals, health systems, CVOs, locum companies and private practices across the United States. She has vast experience as an MSP, including credentialing specialist, provider enrollment specialist, medical staff coordinator, Medical Staff Manager, and CVO Director.

Tammy was a CVO Manager where she was responsible for creating and implementing policies and procedures for a new corporate CVO for a large health system. During her tenure,  the CVO achieved NCQA accreditation and delegated credentialing status with commercial payors. Additionally, Tammy worked as a quality auditor for an NCQA certified managed care company and an Adjunct Instructor teaching medical office systems classes.

Tammy has a BS in Human Services Management and a master’s in healthcare administration with a minor in Education. She is a member of the North Carolina Association Medical Staff Services and the National Association Medical Staff Services. 

Additional Information

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live? No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.

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