For many years, credentialing and onboarding have been looked upon as "clerical" duties instead of critical business and practice management processes. Today, it is evident that when these processes are not managed efficiently and properly, they can - and will- negatively impact a healthcare organization's revenue. Regulatory requirements continue to become more complex and bad or poorly managed credentialing, enrollment, and onboarding processes can put hospitals at risk for compliance violations and allegations of negligent credentialing.
- Define the differences between recruitment and retention
- Identify the essential steps to create an active recruiting and retention algorithm
- Identify CMS regulations for credentialing and privileging
- Identify and evaluate "red flags" in an application
- Define appropriate mechanisms for primary source verification and approved secondary or equivalent sources
- Define the difference between payer enrollment and credentialing
- Avoid the pitfalls common in provider enrollment through awareness of the specific challenges associates with Commercial, State, and Federal health plans
- Identify methods to achieve economies of scale: reduce operational cost and increase revenue
- Determine effective mechanisms for strategically onboarding new practitioners to an organization, e.g. practice, hospital, etc.
7:30-8:00 am Registration and Welcome
8:00-9:00 am Practitioner Recruitment in Rural Healthcare (Basics - recruiting vs. retentions;
developing an algorithm for active recruiting and for retaining practitioners within the
healthcare facility and community)
9 am-12 pm Credentialing (Basics - requirements for verification of credentials, red flags,
negligence in credentialing) Will include a break
12-12:45 pm Lunch
12:45-1:45 pm Payer Enrollment Process and the Financial Impacts (Basics - data gathering -
application processing, timelines, effective dates and financial impacts when
discrepencies or delays arise
1:45-2:45 pm Strategic Positioning of Medical Staff Services and Payer Enrollment in an
Organization (Achieving economies of scale: reduce operational costs - increase
2:45-3:45 pm Break
3-3:45 pm The Importance of an Onboarding Infrastructure (Basic framework to create an
onboarding infrastructure to assist with practitioner retention)
3:45-4:30 pm Panel Question and Answer
Kathy Matzka, CPMSM, CPCS, FMSP
Kathy is a speaker, consultant, and writer with 30 years of experience in credentialing, privileging, and medical staff services. Ms. Matzka worked for 13 years as a hospital medical staff coordinator before venturing out on her own as a consultant, writer, and speaker. She holds certification by the National Association Medical Staff Services (NAMSS) in both Medical Staff Management and Provider Credentialing. She is one of the first recipients of the NAMSS Fellow Designation. The Fellow Designation is the pinnacle of achievement and acknowledgment for the Medical Services Professional (MSP), recognizing a career MSP who has made outstanding contributions to the profession through service as a leader, mentor, and educator.
Merella Schandl, MHA, CPMSM, CPCS
Merella brings over 25 years of health care experience to Anders as a senior health care consultant, having worked with all facets of the industry. She advises hospitals, managed care organizations and physicians on regulatory compliance and credentialing. Merella designs and implement plans for integrating provider enrollment while delegating credentialing and medical staff services to enhance client revenue cycles. She provides practice assessments to independent/group physicians, identifying areas for improvement related to process improvement, design flow, staffing and other processes. As a National Association of Medical Staff Services Instructor, she is able to continue industry education to those seeking certification in credentialing and leadership. A frequent presenter, Merella shares her depth of health care knowledge through local and national speaking opportunities. Merella is heavily involved in industry organizations and is currently pursuing a certification as a Six Sigma Black Belt.