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Enrolling with the Medicare program involves the various CMS-855 forms. There are now seven different forms that must be used by different providers of healthcare services or products. These forms are long, detailed, and sometimes confusing. Not only must they be filed initially for a given provider, but they must also be maintained and updated as appropriate. Due to the increasing complexity of healthcare delivery systems, providers, such as integrated delivery systems or large multi-specialty clinics, may have to maintain hundreds of these forms. The Medicare program uses a revalidation process to periodically require all healthcare providers to resubmit their various 855 forms in order to assure that compliance is being maintained.

In this session, we will review the updates for Medicare provider enrollment and revalidations.

Learning Objective

• Review Medicare Enrollment for Organizations & Individual providers
• Review Location requirements
• Recent Medicare Update
• Review the Revalidation requirements
• Overview Medicare Enrollment Handbook, Chapter 10

Areas Covered in the Session:

• Medicare enrollment for organizations
• Medicare enrollment for individuals
• Revalidation Process
  1. Revalidations Cycles
  2. Cycle 1 Process
  3. Cycle 2 Process
  4. Determining Status and Notification
  5. Time Frames for Completion
  6. Risk Levels
  7. On-Site Visits
• Medicare revalidation for organizations
• Medicare revalidation for individuals
• Medicare Provider Enrollment Continued Education
• Medicare Updates reviewed

Suggested Attendees

• Practice Managers
• Healthcare Billing Specialist
• Staff providing NPI support, NPPES support
• PESC, CPMSM, CPCS
• Staff providing CAQH support
• Clinic Managers
• Allied Health Providers
• Advance Health Practitioner
• Credentialing
• Enrollment
• Office Managers
• Operations
• Revenue Cycle
• Coders
• Clinical Directors
• Practice Owners
• Claims Teams
• MSPs

About the Presenter

Yesenia Servin is an expert in credentialing and provider/payer enrollment with 22 years of experience in the healthcare industry. Yesenia has a deep understanding of Medicare & Medicaid enrollment and is a nationally certified credentialing manager and provider enrollment specialist. Through, YS Credentialing PLLC, Yesenia

• Helps organizations develop and implement best practices guidelines and processes
• Analyzes revenue cycle management
• Guides the credentialing and payer enrollment structure

Yesenia is the payer enrollment lead with TeamMed Global. She manages payer enrollment, keeps team members up to date on industry trends, and is a liaison to all departments that impact payer-enrollment processes. In previous positions, Yesenia has worked with durable medical equipment, hospital and health systems, and community mental health organizations, global managed care organizations as well as providing revenue cycle consulting services to various healthcare providers and organizations.

Yesenia is a current Team Med Global Lead Collaborator, Team Med Global University Faculty, NAMSS member, and is a current and past NAMSS Educational Conference Guest Speaker, a current member of the NAHRI Leadership Council, current trainer for The Chicago School of Professional Psychology and industry trainer. Yesenia studied microeconomics and communications at NEIU and is currently studying healthcare administration at Concordia University Chicago.