Healthcare institutions seeking to execute efficient, high-caliber credentialing and enrollment processes must enlist high-performing professionals. All too often, however, there are no specificjob eligibility criteria for provider enrollment positions other than the ability to type and follow instructions. These scant requirements stand in sharp contrast to the vital part that enrollment professionals play in the revenue cycle management process.

A sneak-peek at results from the 2018 MSP Salary Survey supports the increasing trend of MSPs taking a greater role in provider enrollment and delegated credentialing activities.

A health plan must designate a credentialing committee that uses a peer review process to make credentialing and recredentialing decisions. Members of the committee must include participating practitioners who can review and provide input on applicants for initial credentialing and recredentialing. The credentialing committee is also responsible for reviewing and approving credentialing policies and procedures, as well as reviewing delegated credentialing activities.

To maintain Medicare billing privileges, a provider or supplier (other than a durable medical equipment, prosthetics, orthotics and supplies [DMEPOS] supplier) must resubmit and recertify the accuracy of its enrollment information every five years, a process known as revalidation. Revalidation has become a hot topic over the past few years.

Published 8/23/18

A growing contingent of MSPs are finding themselves managing provider enrollment duties in addition to their existing medical staff credentialing obligations. However, lengthy enrollment turnaround times with payers can hurt your organization’s bottom line. During this 90-minute on-demand webinar, expert speaker Amy Niehaus, CPMSM, CPCS, MBA, will help listeners understand the payer credentialing process and requirements under Centers for Medicare & Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA) standards.

Published 8/23/18

Attaining delegation status with commercial payers is the ultimate way to improve enrollment turnaround time and reduce lost revenue and credentialing delays. During this 90-minute webinar, expert speaker Amy Niehaus, CPMSM, CPCS, MBA, will help listeners identify the benefits of attaining delegation with payers. Participants will learn about the critical steps involved for achieving delegation, as well as the requirements that must be met under National Committee for Quality Assurance (NCQA) credentialing standards.

Published 8/22/18

Largely thanks to smartphones and applications, social media sites are available from any location at any time, seemingly with no restrictions. But “no restrictions” doesn’t mean “anything goes,” especially not for healthcare workers. Just this past June, Georgia dermatologist Dr. Windell Davis-Boutte had her license suspended by the state medical board after patients complained about videos posted on her YouTube account.

Published 8/20/18

Proctoring and the performance of FPPE provides a valuable service to patients and the medical community. It protects patients and can help a colleague identify opportunities to improve the quality of the care he or she delivers. Many medical staff bylaws declare participation in focused review determinations, including proctoring, an important professional obligation of all members. Nevertheless, proctors occasionally face ethical dilemmas in the work they perform. Examples of such dilemmas are represented in the case scenarios that follow.

Take the 2018 MSP Salary Survey today to make sure your professional experiences are represented. The more responses we have, the more meaningful (and actionable) the data will be in the special report we’ll release as a complimentary resource. Beyond dozens of graphs, tables, and figures visualizing 2018 survey results, this report will feature expert guidance for leveraging findings in the field and years’ worth of comparative data. Click here to download last year’s report.

Click here to take the 2018 MSP Salary Survey!

Click here to apply to the CRC contests

"Applying to the CRC Contests became a wonderful networking opportunity for me to share my knowledge and also benchmark with world-class organizations across the country. I have had an absolutely phenomenal experience working with CRC, and moving forward as a judge for the 2018 contest applicants, I will be looking for innovation, creativity, and transformative tools to improve outcomes."
—Raechel Rowland, RN, BSN, LSSBB, co-winner of the 2017 CRC Excellence in Medical Staff Collaboration Award and member of the 2018 and 2019 CRC Contest Committee

The 2019 CRC Symposium Case Study Competition and the 2019 CRC Achievement Awards are two application-based contests that showcase excellence in the medical staff services and leadership fields. Winners, who will be selected by a panel of esteemed industry experts, will receive free admission to and recognition at the 2019 CRC Symposium in Las Vegas, Nevada, February 26-29. For more information, click here.