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Welcome to PMI’sWebinar PresentationBrought to you by:Practice Management Institute pmiMD.comMeet the Presenter On the topic:Tracey TokheimProviderEnrollment/Credentialing Toolsfor SuccessfulTracking

Welcome to Practice Management Institute’s Webinar and AudioConference Training. We hope that the information contained herein willgive you valuable tips that you can use to improve your skills andperformance on the job. Each year, more than 40,000 physicians and officestaff are trained by Practice Management Institute. For 30 years, physicianshave relied on PMI to provide up-to-date coding, reimbursement,compliance and office management training. Instructor-led classes arepresented in 400 of the nation’s leading hospitals, healthcare systems,colleges and medical societies.PMI provides a number of other training resources for your practice,including national conferences for medical office professionals, self-pacedcertification preparatory courses, online training, educational audiodownloads, and practice reference materials. For more information, visitPMI’s web site at www.pmiMD.comPlease be advised that all information in this program is provided forinformational purposes only. While PMI makes all reasonable efforts toverify the credentials of instructors and the information provided, it is notintended to serve as legal advice. The opinions expressed are those of theindividual presenter and do not necessarily reflect the viewpoint of PracticeManagement Institute. The information provided is general in nature.Depending on the particular facts at issue, it may or may not apply to yoursituation. Participants requiring specific guidance should contact their legalcounsel.CPT is a registered trademark of the American Medical Association.Practice Management Institute 8242 Vicar San Antonio, Texas 78218-1566tel: 1-800-259-5562 fax: (210) 691-8972info@pmimd.com

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Provider Enrollment/Credentialing TrackingPresenter: Tracey TokheimThursday, October 24, 201912:00 PM CST1AGENDA Definitions Who is Enrolled? Information Needed to Enroll Polling Questions Barriers to Successful Enrollment Keys to Success Educational Organizations What is Delegation Barriers to Data Integrity – Managing multiple data sources Establish a successful process for obtaining information Application Process Application Process Tools Provider Enrollment Activity Tracking2Proprietary & Confidential21

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019AGENDA (cont’d) Tools for Tracking the Moving Parts/Pieces Must Knows about Application Completion Application Review Application Reg Flags Software Solutions–––––PECOSHealthStream (OneApp, Morrissey)CactusCAQHMicrosoft using Access/Excel Review of Polling Question Results References Contact Information Q & A3Proprietary & Confidential3Definition and Differences betweenProvider Enrollment andCredentialing/Privileging Credentialing/Privileging Definition Provider Enrollment DefinitionThe application process by which apractitioner is approved to seekreimbursement from government and/orthird party payers OR seek admittingprivileges at a hospitalIs the process of obtaining, verifying andassessing the qualifications of ahealthcare practitioner to providepatient care services in or for ahealthcare entity.Privileging is the process by whichauthorization is granted by a hospital toa practitioner to provide specific patientcare service in a hospital.4Proprietary & Confidential42

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Who is Enrolled? Independent Practitioners: licensed by the state and allowedto practice independently (e.g., Physician) Dependent Practitioners: able to provide care under thedirection or supervision of a medical staff member For health plan enrollment, typically it is a process forproviders who bill for professional services under theirown name. There may be exception to this rule. For hospital enrollment, typically it is a process to obtainhospital admitting privileges.Facilities: A building or structure in order to bill a technical fee.Proprietary & Confidential5What information is needed?Application ElementsApplication ElementsPersonal Demographic InformationEducationTraining InformationCredentialing Contact InformationHospital Affiliation(s)Work HistoryGaps (e.g. education, work)Reference InformationLiability InsuranceLiability Case InformationImages of DocumentsAdditional DocumentsPrivilege InformationCredentialing Contact InformationOffice Location Information(including TIN & NPI)ID Numbers (NPI, DriverLicense/State ID)Proprietary & Confidential63

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Barriers to Successful ProviderEnrollment Changing Industry – continuous learning Enrollment process (forms) Requirements Timing for completion Many moving parts and tracking/prioritization High staff turnover Application volume not balanced Lack of support or knowledge within yourorganizationProprietary & Confidential7Key to Success Educate providers and your organization to understand theimportance of provider enrollment and the impacts it has on revenue Get commitment from the TOP down in your organization to adopt astreamline process with commitment to continued review Establishing a process for obtaining the relevant information for eachplan/hospital Obtain all information the FIRST TIME and as quick as possible Create and maintain connections with the plans/hospitalsBe organized to track all the moving pieces so nothing falls throughthe cracksMentor new people to help them be successful. Give backProprietary & Confidential84

Practice Management Institutewww.pmiMD.com Webinar/Audio ConferenceOctober 24, 2019Educational OrganizationsNAMSS – www.NAMSS.orgState Medical Staff Services entitiesPeer GroupsPayer Newsletters or Websites CMS – www.CMS.govState MedicaidPayersProprietary & Confidential9What is Delegation?A formal process by which theorganization gives another entity theauthority to perform certain functionson its behalf. Although the organizationmay delegate the authority to perform afunction, it may not delegateresponsibility for ensuring that thefunction is performed appropriately.Proprietary & Confidential105

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Steps to Becoming Delegated Evaluate the delegation agreement Make sure it contains all of the required elements forcompliance Make sure it’s mutually agreed upon Ensure all responsibilities are outlined in detail Has to include at minimum semi‐annual audits Determine the process and handoffs through the completeprocess Identify any remedies if all obligations do not occurConstruct a delegation agreementIdentify a pre‐delegation evaluation processDefine delegation oversight/annual audit processEvaluate reportingApproval of final reporting outcomesProprietary & Confidential11Barriers to Data Integrity – Managingmultiple data sources Solid identification of data movement to source(s)Adoption of who’s data is correct (dataintegrity)2 Directional Data MovementLimitation of different technology/languagebarriersExpertise outside of the EnrollmentDepartment needed (IT constraints)Proprietary & Confidential126

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Tools for Tracking the MovingParts/Pieces Software programs which includetrigger or task notification Spreadsheets Reminders on your calendarProprietary & Confidential13Keys to Success Communication Internal External Process – review and revise Knowledge is KEY Create a toolbox because not every execution of aprocess works the same Review and REVISE REPEATProprietary & Confidential147

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Establish A Successful Process forobtaining all Information Create a communication plan between you, the provider, and any otherparty involved directly or indirectly in this process. Communicate from the beginning the information needed, expectationsand time lines; and the reason why you need this information. Create a process internally and externally to identify each member ofthe teams roles and responsibilities. Make sure the requirements for each plan or hospital includingapplications, additional documents, and accepted submissions optionsare clearly defined and understood. Required for Success: PERIODICALLY REVIEW THE PROCESS THEASK FOR FEEDBACK TO BETTER THE EXPERIENCE.Proprietary & Confidential15Provider Enrollment ActivityTracking Create a system that allows you to track where the application is at inthe process and use a “Next Due Date” system to make sure thingsdon’t fall through the cracks. Create a system that all staff know and have access to.Create a system to ensure providers understand the importance of fastresponses and expectations. Work your executive leadership to provide ongoing education andawareness of the importance of provider enrollmentCreate a system that all staff knows and has access to.Proprietary & Confidential168

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Application Process Application doesn’t mean paper any longer!!! Need to define clear hand-offsPrepare your process for both paper and electronic databaseapplication processes.Define a process to track and manage recred due datesExpirables ManagementOther enrollment functions Meaning UseDirectory ManagementProprietary & Confidential17Application Process ToolsProprietary & Confidential189

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Proprietary & Confidential19Software Solutions ApertureECHO (HealthStream) formerly SyMedMorrissey (now HealthStream)SymphrCactusVistarCredSimpleHome grown systemsOther solutions Paper PECOS (Medicare’s own system) CAQHChanging quickly in this industry .Proprietary & Confidential2010

Practice Management Institutewww.pmiMD.comWebinar/Audio ConferenceOctober 24, 2019Must Knows about ApplicationCompletion Make sure the information is accurate and clearly identified to deemthe application is complete or if additional information is needed. Document process and time line expectations to organization andprovider Provider needs to include three references for hospitalcredentialing/privileging. One reference should be someone who has personal knowledge ofcurrent clinical skills, observation of work, and ability to workcooperatively with others Another reference should be a professional peer reference from apractitioner in the same specialty Another reference should be someone who has recently beenresponsible for the applicant’s practice at a healthcareorganization (department/section chair, chief of staff, etc.)Proprietary & Confidential21Application Review Make sure all gaps in time frames are explained Discrepancies in Information – Application/CV/VerifiedInformation – Inconsistent answers – Discrepancies betweenapplication and primary source Large number of malpractice cases and frequent movesReview for missing information/unanswered questionsAll Yes Affirmative Answers to Disciplinary Questions need to beexplainedVague references – may refuse to complete evaluationCancellation or denial of liability coverageInformation from the NPDB does not match applicationinformationProprietary & Confidential2211