Provider On-Boarding: Does Provider Experiences Matter? If Yes, Let s Talk

Transcription

1 Provider On-Boarding: Does Provider Experiences Matter? If Yes, Let s Talk Session Code: WE09 Time: 10:30 a.m. 12:00 p.m. Total CE Credits: 1.5 Presented by: Alicia Mendez, CPCS, CPMSM

2 Provider On-Boarding: Do Provider Experiences Matter? By Alicia I. Mendez, CPCS, CPMSM President & CEO AIA Credentialing & Consulting Services Unequivocally! Provider Satisfaction = 1

3 Learning Objectives Illustrate why provider experiences matter to the success of onboarding Identify characteristics of solutions that fail to provide transparency & engage the provider Propose tools/guides to assess or improve your processes. Starts & Ends with us Privileging Onboarding Provider Enrollment MSP/MSO/ MSS What does On-boarding Mean? Introduction/Start 40 Application 25 Credentialing PSV/ Privileging / Membership 20 Payor Enrollment 10 Re-Credentialing 5 2

4 Introduction or START Marketing Campaigns Recruiters Interviews Dept. Chair CMO/Admin Pre Application HR Vetting Begins Application Paper VS Online PSV 3

5 Provider Enrollment Cycle How do they know??? Prepare Application Payer ID & Effective Date Review/Approval & Signature by Provider Follow-up with Payer Send Application to Payer Provider Enrollment CAQH 4

6 Re-Credentialing, etc Management of cycles PSV conducted by MSO/MSP/MS Communication of PSV process Communication of Completion (approval/denial) Expireables Ongoing Monitoring What about the current status-quo FAILS TO ENGAGE PROVIDERS??? Re-Credentialing/ Continued Relations Initial Application or Starting Point Provider Enrollment Primary Source Verification How can we do it better? Let me COUNT THE WAYS 5

7 Application Solutions Solutions to PSV PE Solutions The Basics Organization Name Tax Identification Number Address (complete address) Phone & Fax Contact Contact person responsible for clarifying enrollment question (specific to TIN/Payer assignment) Do you utilize CAQH? If yes, please explain how the CAQH database is utilized. How is enrollment performed? What software or program do you utilize to assist in the enrollment process? Do you have education process/policy which concurrently reviews credentialing and enrollment updates/trends? If so, please provide. 6

8 PE Solutions Continued Solutions to manage Re-Credentialing & Ongoing Tasks Hit OK to send Applications OK Daily Expireables 10 Overdue Expireables 1 Expireables within 30 Days 30 Expireables within 60 Days 15 Expireables within 90 Days 150 Expireables and Ongoing Monitoring 7

9 Expireables and Ongoing Monitoring Expireables and Ongoing Monitoring Lets re-cap some of the tools Establishing or Maintaining your Onboarding Process Checklist PE Assessment tool 8

10 Selecting and leveraging technology. Getting buy-in from the right mix of stakeholders is essential. All departments that will be impacted should be consulted and/or asked to participate. It s a team effort. The right mix of people, process and tools is essential and each organization needs to figure out what the right mix should be for their organization. You can t improve what you can t measure. Make sure a vendor s solution allows you to measure and adjust processes as needed. Get consensus on what will be measured and how results will be shared and used. Resistance to change should be anticipated...minimize resistance by communicating why it s needed along with specifics around how changes will help, and how change will be managed Integration should be simplified. The ability to connect to other hospital systems should not be overlooked. Selecting and leveraging technology (cont d). Don t shy away from leading edge solutions..and avoid bleeding edge technologies. Web technology is ubiquitous. Vendor s solutions should be fully web based to allow clients to leverage a solution across an organization. Unlimited user license pricing should be part of your license agreement. Beware of the that s how we do it here syndrome.. a vendor solution should facilitate making use of industry best practices while allowing also allowing providing flexibility for truly specific client needs. Would you buy a car without test driving it? Some vendors are prepared to conduct well-defined low-cost Proof of Concepts for serious prospects. Speak with vendors clients. They are often willing to share their experiences..good ones and otherwise. Some clients are even willing to host a site visit. Questions? 9

11 Feel free to REACH OUT Alicia I. Mendez, CPCS, CPMSM President & CEO AIA Credentialing & Consulting Services 285 Westside Avenue Jersey City, NJ Tel: Fax: Visit us on the web Special Thanks Haejune Antequera Mike Levine Virginia Lopez Luis Mendez Shirley Thompson Hospitals, Surgery Centers, Large multi-specialty groups MSP s everywhere 10

12 Provider Enrollment Process Details Collection Form Entity Structure Details Organization Name Tax Identification Number Address (complete address) Phone & Fax Contact Contact person responsible for clarifying enrollment question (specific to TIN/Payer assignment) If multiple TID numbers exists the above mentioned information is needed along with a copy of the currently utilized w-9 Single Specialty Group Entity * Group Multi-Specialty Group Hospital system* Other * Kindly provide brief narrative describing entity structure, including ownership details. You may make additional copies of this page for each respective tax if the details are different Created by AIA Credentialing & Consulting Services

13 Provider Enrollment Process Details Collection Form Department Details # of associates dedicated to enrollment function. Provide titles, and if any are certified. How is enrollment performed? Payer is assigned to associate Practitioner is assigned to associate Other, Explain or provide applicable policy Who do you perform enrollment for? What software or program do you utilize to assist in the enrollment process? What core reporting mechanism is utilized to track the steps in the enrollment process? Define/provide core set of reporting and or any reporting details. Policies and procedure, Forms What functions is your department responsible for? Practitioners once they are approved by the BOT, and designated by policy Practitioners limited to hospital/facility based clinics Groups designated by the system Other, Explain Kindly provide any policy related to the enrollment process and related forms and or visual tools utilized by the staff for processing. For example(i.e Request for service form, enrollment policies (from notification to begin enrollment through the obtainment of provider ID and effective date), flowcharts, delegation, quality review prior to payer submission, etc.) Primary source verification (credentialing) initial re-credentialing Provider Enrollment demographic changes initial re-credentialing Maintenance of repository for PSV PE Both Created by AIA Credentialing & Consulting Services

14 Provider Enrollment Process Details Collection Form Payer Details List of Payers Payer repository Payer application/details Kindly provide list of payers which identify if the respective TID retains a group contract (advise if delegation is an attribute of the agreement) or, individual contract. If collection of sub product (specific payer ID) is required, sub products must be listed on the Payer listing Provide the policy or document which indicates how the payer specific details are maintained, who is responsible for maintaining them, and how often updates/confirmation are sought. What specific form (application/par form) is required by the payer? What specific supporting documents are required, per payer? What if any specialty, allied health practitioner or ancillary service providers are prohibited from participating in the network (closednetwork)? Process Details Do you have written policy and procedures that explain how the credentialing/enrollment process is executed? If so, please provide. Do you have education process/policy which concurrently reviews credentialing and enrollment updates/trends? If so, please provide. Do you utilize facility specific (initial & re-credentialing ) applications? If so, please provide copies of applications, checklists, and letters utilized to solicit information or supporting documents from the practitioner(s)? Are you responsible for maintenance of the practitioner repository? PSV PE Both Do you utilize CAQH? If yes, please explain how the CAQH database is utilized. YES NO YES NO YES NO YES NO YES NO Print Name Person completing assessment Signature and Date Created by AIA Credentialing & Consulting Services

15 Provider/Practitioner On-Boarding Clinical Leadership Project Timeline Description/Notes Start Date End Date Communication with clinical leadership or their administrative staff on the required documentation to initiate the onboarding process Understanding, how departmental rules and regulations affect initial recruitment and vetting process Medical Staff Office/Medical Staff Professional Project Timeline Description Start Date End Date Develop/Maintain step by step credentialing process for applicants and or applicant's staff detailing the onboarding process to include highlights, and timeframes leading to approval (i.e. File processing, PSV, Chairman review and recommendation, Committee(s) and governing body approval). Develop/Maintain the onboarding process (Concurrently Update) Develop/Maintain the PSV process (Concurrently Update) Provider Enrollment Project Timeline Description Start Date End Date Complete a PE assessment Define Hand off (if required) between PSV completion/appointment and initiation of PE Define reporting Structure (Standing Reports) Define your Payer list Determine or develop your PE approach base on PE assessment If participating in a Delegated Agreement: Define Hand off (is required) between PSV/appointment and Initiation of PE Reporting Structure (Standing Reports) Understand financial implications of payer list (who is your priority) Recruitment Project Timeline Description/Notes Start Date End Date Determine Utilization Parameters for recruiters to track their provider communication of prospective providers (i.e. permission granted of updates versus view only inclusion of key stakeholders). Development/Maintenance of Recruitment Include key stakeholders in communication process review Initial/Ongoing Communication with Clinical and Entity or Leadership Maintenance of Recruitment Marketing Material Other Description: Always include key stakeholders Departmental Leads Finance Infection Control Medical Records Performance Improvement/Quality Project Timeline Notes