August 21, 2024 • 22 mins
With the recent CMS updates about provider enrollment, we felt that we needed to bring you some timely information about these changes. We sat down with Raquel Grizzard SHP’s Provider Enrollment expert. She has been working in Provider Enrollment since 2014 and has seen her fair share of changes, but none as dramatic as this all at once.
We discuss DMEPOS, CHOW Filing, changes to the 8550, the new specialists that have been added, and more. Join Raquel Grizzard as she shares her insight and tricks of the trade for all things Provider Enrollment.
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Hosts: Jason Crosby & Aaron C Higgins
Executive Producers: Mike Scribner & John Crew
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Aaron Higgins (00:00):
Welcome to Beyond the Stethoscope Vital
Conversations with SHP.
As we take a summer break toprepare for the exciting Season
5, we're revisiting some of ourmost informative episodes to
keep you up to date on thelatest in healthcare.
In this episode from Season 2,we sat down with Raquel Grazard,
SHP's Provider EnrollmentExpert.
Raquel has been navigating thecomplexities of provider
(00:22):
enrollment since 2014 and haswitnessed many changes over the
years, but none as dramatic asthe 2023 CMS update.
So while these changes wereintroduced in 2023, they
continue to be highly relevanttoday.
Raquel shares her deepexpertise on a range of topics,
including DME POS, CHOW filing,changes to the 8550 form and new
(00:45):
specialists that have beenadded to the enrollment process.
So, whether you're navigating anew provider enrollment or are
seasoned pro, Raquel's insightsand tips are invaluable for
navigating these significantchanges.
Don't miss this chance torevisit a critical discussion
that can help you stay ahead ofthe curve.
If you find this episodehelpful, please rate and share
our podcast in your favoritepodcast app.
(01:06):
It really helps the show.
Thank you for tuning in, andlet's join Raquel Grizzard as
she breaks down providerenrollment in this vital
(01:27):
conversation.
Welcome to Beyond theStethoscope Vital Conversations
with SHP.
Normally, today's episode wouldbe the latest headline news
with myself and Jason, but withrecent CMS updates about
provider enrollment, we felt theneed to bring you some timely
information about these changeswas more important.
So we sat down with RaquelGrisard, SHP's provider
(01:51):
enrollment expert.
She's been in providerenrollment since 2014, and while
she's seen her fair share ofchanges, none have been dramatic
as this.
All at once, we discussed DMEPOS, chow filing, changes to the
8550, the new specialists thathave been added, and much more.
Are you ready for this vitalconversation?
(02:11):
Let's get started.
Jason Crosby (02:22):
All right.
Today our guest is SHP's veryown Raquel Grisard.
Raquel is our EnrollmentInitiatives Manager, who has
been with SHP for eight yearsnow, primarily in our provider
enrollment and credentialingareas.
Raquel, thanks for joining ustoday and welcome to the podcast
.
Raquel Grizzard (02:39):
Hey guys, good to be here.
Jason Crosby (02:42):
We are going to dive into lots of good provider
enrollment.
Guys, good to be here.
We are going to dive into lotsof good provider enrollment.
We often joke it's probably themost undervalued,
underappreciated aspect ofprovider reimbursement in
particular that folks just don'tappreciate.
So we're really glad to havesomeone with Raquel's expertise,
also known as the enrollmentslayer.
All right, so let's just jumpright into it.
(03:03):
Cms issued some significantupdates provided enrollment
space for 2023.
Can you highlight a few ofthose for our audience?
Raquel Grizzard (03:13):
Yes, so we do have some exciting changes on
the horizon here.
First one up on the docket theDME space for enrollment.
So we've got a contractorchange with how these are
processed and the process isstill online through PECOS.
You now have two differentcontractors We've got Novitas
(03:37):
and we've got Palmetto handling.
They're splitting the countryhere doing these and so with
that change of course, everychange brings challenges, of
course.
Jason Crosby (03:48):
So what's these types of changes what's probably
the first one you're seeingthat you're in your space today
that are impacting providers,mostly on the day-to-day.
Raquel Grizzard (04:00):
So having any DME changes or initial
enrollments, the process haschanged a little bit.
The contractor we haveexperience with Novitas.
They reach out, you know, adifferent way than the old
contractor used to.
They're looking for differentbenchmarks, different things on
the applications.
And so what we're starting tosee is our processing time has
(04:21):
increased a little bit here withthis contractor.
Our processing time hasincreased a little bit here with
this contractor.
That may get better as timegoes on and they get used to
their new role and their newresponsibilities.
But we are seeing someincreased processing time for
DME suppliers.
And the next point, which ispretty important for these
offices that they need to beaware of we are seeing an
(04:43):
increase in site visits,especially with the DME space.
They are coming out to checkyour door for your hours, make
sure those are posted, theymatch your NPI database, make
sure you're storing everythingcorrectly.
So with the release on some ofthe COVID restrictions, we are
seeing those CMS agents back inthe field.
Aaron Higgins (05:03):
Well, and certainly the last thing you
want to see is the CMS comingand knocking at your door.
But what can a practice expectif they do come knocking, Are
they going to get penalized ifsomething's wrong, or are they
given a window of time to fix it?
Raquel Grizzard (05:20):
Sure, If there are any deficiencies, they will
let you know what the problem is, how you can remedy that and
what your timeframe is to getthat corrected or rectified.
And so some things you staff beaware that someone may come for
(05:44):
a site visit and make sure thatyour ducks are really in a row
and that everyone isanticipating said visit.
Aaron Higgins (05:51):
Do they send a letter or do they just show up?
Raquel Grizzard (05:53):
No, you're not going to get any heads up on
this one.
They are just going to show upwhenever they want and they're
going to be looking for thosethings on a surprise visit.
Jason Crosby (06:05):
Kind of like good old Jayco visits in the hospital
setting right.
Raquel Grizzard (06:08):
It's exactly like that.
They will show up withoutwarning.
Jason Crosby (06:14):
And for those maybe that haven't experienced
it, what are some of theconsequences?
You're not prepared.
They show up, you don't havethe check boxes marked.
What usually happens after thatsite visit that folks can learn
from.
Raquel Grizzard (06:28):
So they'll let you know what's deficient, how
long you have to fix it.
So the first point here is youknow, if you're doing an initial
enrollment and you're waitingto open your doors, this is
going to delay patient care.
That's the most important partthat practices need to realize
manage your expectations andbuild in that extra time.
You know what I mean.
(06:49):
Our processing time they say,okay, you have 120 days, but if
they show up and you havedeficiencies that have to be
corrected, you're going to haveto add more time to that.
So definitely be aware thatyour processing time will be
increased for any deficiencies.
Your processing time will beincreased for any deficiencies.
(07:10):
The penalization part we're notseeing anything going on with
that right now.
Luckily we don't have anypractices that have had any real
deficits.
They're just going to ask youto either move your stock or
make sure your hours that areposted on your door match NPI.
And it's really just having youknow your T's crossed and your
I's dotted.
Jason Crosby (07:29):
Now, you mentioned before initial enrollment and
we obviously go through that alot initial enrollment,
maintenance of enrollment, chals, et cetera.
I noticed that there were somechanges along those lines in
terms of what's allowed nowgoing forward when you submit
for initial enrollment, when yousubmit for CHAL.
What are some of thoseimpactful changes?
(07:52):
Like you know, efts you're onlyallowed a certain number of
EFTs, things of that nature thatyou saw that may be impactful
to providers.
Raquel Grizzard (08:01):
So that's a good question.
Especially with a startup, youreally need to make sure that
your bank is set to go.
What we are seeing is a lot ofpractices will start up.
They get a business checkingaccount and there's no money in
it, and when Medicare goes toverify that EFT, if there is no
money in the account, your EFTwill not be processed.
(08:22):
So these are little things thatwe end up learning on the back
end when our practices, you know, get dinged for things like
that, so they are actuallyverifying your EFTs.
If you're making a change toEFT, you are now required to
delete your old EFT agreementand do a complete new one, and
(08:43):
there can be a gap in that ifyou're not careful, where you're
seeing 15 to 30 days wherepaper checks will come instead
of actual direct deposits, andso those changes can take
anywhere from 30 to 60 days toprocess when you do change EFT.
So your billers need to beaware that if payments stop
coming, you might have to startlooking for paper checks or do
(09:04):
your best to mitigate thatpatient flow if you're a very
heavy Medicare practice.
Jason Crosby (09:09):
Very important point you made there too.
So many nuances and details inthe process.
A delay or an inaccurate formcan delay payment, and I think
folks appreciate that enough.
So that's a great statement youmade there.
Aaron Higgins (09:24):
So, speaking of nuance and details, which of the
providers are able to enroll onthe 8550?
Raquel Grizzard (09:32):
So, on our 8550 applications, medicare is
currently allowing 13 providertypes, and so you have your
different flavors of doctors,right your MDs, your DOs,
dentists, podiatrists,optometrists.
We are also having mid-levelsand extenders that are able to
(09:54):
enroll in the 8550.
So your PAs, nursepractitioners, a various amount
of psych providers, midwives,social workers, and then the key
here is residents.
So we do have residentphysicians that are able to
enroll, as well as retiredphysicians who are maintaining a
license.
Jason Crosby (10:14):
Now, speaking of provider types, erin and I have
talked about in the past theruling regarding the rural
emergency hospitals that cameout last year, the designation
that many folks are looking intoYet we know many aren't
pursuing, but still of interest.
What impact has that had interms of maybe as a new provider
type that folks need to beheads up about in 2023, that REH
(10:40):
designation?
Raquel Grizzard (10:42):
Excellent.
So this is really important andthis is a great thing that
they've done to help close thegap for some of these really
rural areas where you may nothave enough care.
And so in the past, cms andother various organizations have
tried to mitigate that gap incare by offering the rural
(11:05):
physician tax credit.
You get a certain amount of yourstudent loans that are forgiven
if you will go and you willwork for two to three years in a
rural setting, because we justhave a huge gap in care out
there.
Right, you have a little teeny,tiny county hospital and you
don't have a lot of providersout in that area to serve that
population, and that populationis aging as well, and so it's
(11:25):
very important that we have carein those areas, and so Medicare
established the Rural EmergencyHospitals designation.
It's a provider type that youcan actually not only initially
enroll for, but you can convertyour current enrollment, which
is excellent If you're already afacility that somehow you now
(11:46):
meet this criteria.
Instead of doing a completelynew enrollment, you can convert
yours with a change ofinformation, which takes
significantly less time toprocess.
So they're trying to close thatgap here by providing that care
and cutting down the time ittakes to actually provide that
care for those people out there,that vulnerable market out in
(12:06):
those rural areas provide thatcare for those people out there,
that vulnerable market out inthose rural areas?
Aaron Higgins (12:11):
I know Jason and I have talked a little bit about
the REH.
At least in the last season wetalked about it.
Have you seen a rush towardsthat?
I know we're still in the veryearly days of it, but from your
perspective, have we seenhospitals or clinicians heading
that direction?
Raquel Grizzard (12:28):
No, we do service a lot of rural
facilities.
The criteria it's not widecriteria, so to be eligible to
convert you do have to be acritical access hospital or
rural hospital that did not havemore than 50 beds.
So we're talking about reallysmall facilities here.
(12:51):
You're allowed to provide youremergency services, observation,
but are prohibited providinginpatient services.
So we don't have a lot thatmeet that criteria.
But we know that they are outthere.
You know we're getting wind ofit.
People are calling to ask foradvice and help and you know how
they can go about that.
(13:11):
Do they meet that criteria?
That need is there absolutelyand I think we're going to how
they can go about that.
Do they meet that criteria?
That need is there absolutelyand I think we're going to see a
shift in facilities that domeet that criteria, definitely
moving towards that what advicewould you give to those types of
providers looking to make thatconversion from the enrollment
aspect to be best prepared?
Jason Crosby (13:30):
I know you guys have a tremendous checklist.
You kind of go through any kindof of details or hey, here's
the top three takeaways ifyou're looking to make that
conversion to best allow forthat process to take place.
Any tips for those folks?
Raquel Grizzard (13:45):
Definitely.
So.
We're going to want to makesure you allot enough time to do
that.
You know, we know that this isan emergency thing here, but
managing expectations is alwayskey.
Know that you're going to haveprocessing time.
The second part of that is itdoes cost money, right, you know
everything costs money thesedays.
(14:05):
The fee to do that initialapplication has gone up from
$631 to $688.
So making sure you have thefunds to pay for that.
And then you know, getting allof your other ducks in a row
with your paperwork.
You are going to have to uploaddocumentation with this that
(14:27):
proves that you meet thesecriteria.
And so making sure you not onlydetermine, yes, my facility
meets this criteria.
Make sure you can prove that onpaper.
So you want your time, yourmoney and you know your proof
that you meet this criteria,because you know CMS is going to
ask for all of that.
Jason Crosby (14:46):
Now kind of take a little bit of a pivot here.
We've talked about some of thebigger impacts from this ruling.
What other obstacles, barriers,challenges, however you want to
put it that you're seeing fromproviders as you take them on as
a client?
What are some of the whetherit's just education, background
(15:07):
documentation they're notproviding?
What are some of the biggestheadaches that just come right
to the top when dealing with aprovider today that they need to
learn from?
Raquel Grizzard (15:17):
The biggest issue we are faced with is
always the time managementaspect.
We realize this is real lifeand we don't always get a
multi-month heads up when aprovider is coming.
But the more time we have toprepare ahead of time and submit
that enrollment, the better.
What we're finding is, you know, we get notice that a provider
(15:39):
is hired and they're coming onand they start in two weeks.
In two weeks we can't haveenrollment processed, you know.
And so at that point yourphysician's completely out of
network and the office managersare trying to build them a
patient base.
They're scheduling patientslike crazy, trying to get them
in the door, and at that pointthere's no money coming in from
(16:00):
that.
And so you either chalk that upto that's the cost of doing
business or you try to find away to not have that happen
again, and that only.
The only solution is time here.
Right, we need more time, andthe providers don't understand
that either, and I think that'sthat's.
There's a huge gap in theeducation from when they come
out of school and they startworking.
(16:21):
They don't know how thatprocess works.
And so, you know, educating notonly the practices but those
physicians as well.
They need to become morefamiliar so that they can help
play their own part in thatprocess.
Aaron Higgins (16:33):
To become more familiar so that they can help
play their own part in thatprocess.
Ideally, how long should apractice notify you or how soon
should they be starting thatprocess?
So what behind the ears, freshout of medical school clinician
wants to start.
Are we looking at 30 days 60days, Typically?
What are we looking at 30 days,60 days, Typically?
What are we looking at?
Raquel Grizzard (16:54):
When we get fresh providers out of residency
you know most residencyprograms end at the end of June,
beginning of July we like tohave notice by March, april that
hey, we've got this person onthe hook.
We want to contract with them,Ideally four to six months,
because the legal aspect behindit is that these insurance
(17:18):
companies legally have up to 180days to process credentialing.
That's six months.
It's a huge chunk of time andthis is a necessary component.
Right, we have doctors out herepretending to be doctors who
don't have the necessarycredentials, and so that's how
this process began.
Right, we want real providers,we want good providers, and so
(17:43):
we need the time to make surethat we have safe care out there
.
Aaron Higgins (17:47):
Right.
We don't want a Frank Abagnalesituation where someone has
literally walked in off thestreet and starts providing care
to patients.
Raquel Grizzard (17:56):
It's scary and it continues to happen and I
just I can't imagine how thisactually happens, but it does.
Aaron Higgins (18:05):
That's amazing.
Okay, Jason, I know we'recoming right up on time here.
Got some more questions.
Jason Crosby (18:12):
Yeah, I guess, ra raquel, just maybe to wrap it up
, we've given some really goodadvice to folks and some updates
that have come down the pipe.
What other maybe pe tricks ofthe trade you know key takeaway
to take from this?
As a provider let's say we, youknow we have a practice
administrator, hospitaladministrator, listening what
key, what key tricks of thetrade would you give to?
Raquel Grizzard (18:35):
them.
If you are managing yourenrollment in-house, if you've
got someone in-house that'sdoing that, make sure that you
have an organized process inplace.
This is a very process-driventhing here.
Credentialing you have veryspecific steps and don't get me
wrong, the process goes off therails right.
(18:55):
Somebody doesn't receive yourcredentialing app.
It takes longer.
There's an issue, we hear you.
But by being organized andhaving a very clear process with
actual deadlines in it, you canhelp try to prevent some of
those issues.
And so the organization isreally going to be key,
especially if you have more thanone staff member doing
(19:16):
enrollment in your office.
If you have a two-person teamor anything bigger than that,
you're definitely going to needa clear, defined process for
everybody to follow and to theeveryday operations of provider
enrollment Again an areaseverely underappreciated,
undervalued.
Jason Crosby (19:36):
So we really appreciate Raquel's expertise
and time the enrollment slayerfor SHB for joining us today,
and with that we wish everybodya great rest of your day and
week.
Aaron Higgins (19:49):
Thank you for joining us, raquel, thanks for
having me.
Guys, it was great You've beenlistening to, beyond the
Stethoscope, vital Conversationswith SHP, a production of
Strategic Healthcare Partners.
Jason Crosby (20:02):
For more information about our podcast,
including back episodes, shownotes, transcripts and more,
visit our website at shplccomslash podcasts.
Aaron Higgins (20:12):
And I know you've heard it before, but please
consider rating our podcast andyour favorite podcast out.
It helps make others aware ofthe show.
Jason Crosby (20:19):
And our podcast wouldn't be possible without our
wonderful team of folks.
Aaron Higgins (20:23):
Editing and production assistance by Nyla
Weave and myself, Aaron Higgins.
Jason Crosby (20:28):
And your episode hosts are Aaron Higgins and
myself, Jason Crosby.
Aaron Higgins (20:32):
Our social media coordinator is Jeremy Miller,
our Aaron Higgins and myself,jason Crosby.
Jason Crosby (20:35):
Our social media coordinator is Jeremy Miller.
Our executive producers arealso our principals Mike
Scribner and John Crew.
Aaron Higgins (20:40):
For more from SHP , consider following us on
social media, including Facebook, twitter and LinkedIn.
Jason Crosby (20:49):
And, as always, thank you for listening and have
a great, wonderful day.
Welcome to Beyond the Stethoscope Vital
Conversations with SHP.
As we take a summer break toprepare for the exciting Season
5, we're revisiting some of ourmost informative episodes to
keep you up to date on thelatest in healthcare.
In this episode from Season 2,we sat down with Raquel Grazard,
SHP's Provider EnrollmentExpert.
Raquel has been navigating thecomplexities of provider
(00:22):
enrollment since 2014 and haswitnessed many changes over the
years, but none as dramatic asthe 2023 CMS update.
So while these changes wereintroduced in 2023, they
continue to be highly relevanttoday.
Raquel shares her deepexpertise on a range of topics,
including DME POS, CHOW filing,changes to the 8550 form and new
(00:45):
specialists that have beenadded to the enrollment process.
So, whether you're navigating anew provider enrollment or are
seasoned pro, Raquel's insightsand tips are invaluable for
navigating these significantchanges.
Don't miss this chance torevisit a critical discussion
that can help you stay ahead ofthe curve.
If you find this episodehelpful, please rate and share
our podcast in your favoritepodcast app.
(01:06):
It really helps the show.
Thank you for tuning in, andlet's join Raquel Grizzard as
she breaks down providerenrollment in this vital
(01:27):
conversation.
Welcome to Beyond theStethoscope Vital Conversations
with SHP.
Normally, today's episode wouldbe the latest headline news
with myself and Jason, but withrecent CMS updates about
provider enrollment, we felt theneed to bring you some timely
information about these changeswas more important.
So we sat down with RaquelGrisard, SHP's provider
(01:51):
enrollment expert.
She's been in providerenrollment since 2014, and while
she's seen her fair share ofchanges, none have been dramatic
as this.
All at once, we discussed DMEPOS, chow filing, changes to the
8550, the new specialists thathave been added, and much more.
Are you ready for this vitalconversation?
(02:11):
Let's get started.
Jason Crosby (02:22):
All right.
Today our guest is SHP's veryown Raquel Grisard.
Raquel is our EnrollmentInitiatives Manager, who has
been with SHP for eight yearsnow, primarily in our provider
enrollment and credentialingareas.
Raquel, thanks for joining ustoday and welcome to the podcast
.
Raquel Grizzard (02:39):
Hey guys, good to be here.
Jason Crosby (02:42):
We are going to dive into lots of good provider
enrollment.
Guys, good to be here.
We are going to dive into lotsof good provider enrollment.
We often joke it's probably themost undervalued,
underappreciated aspect ofprovider reimbursement in
particular that folks just don'tappreciate.
So we're really glad to havesomeone with Raquel's expertise,
also known as the enrollmentslayer.
All right, so let's just jumpright into it.
(03:03):
Cms issued some significantupdates provided enrollment
space for 2023.
Can you highlight a few ofthose for our audience?
Raquel Grizzard (03:13):
Yes, so we do have some exciting changes on
the horizon here.
First one up on the docket theDME space for enrollment.
So we've got a contractorchange with how these are
processed and the process isstill online through PECOS.
You now have two differentcontractors We've got Novitas
(03:37):
and we've got Palmetto handling.
They're splitting the countryhere doing these and so with
that change of course, everychange brings challenges, of
course.
Jason Crosby (03:48):
So what's these types of changes what's probably
the first one you're seeingthat you're in your space today
that are impacting providers,mostly on the day-to-day.
Raquel Grizzard (04:00):
So having any DME changes or initial
enrollments, the process haschanged a little bit.
The contractor we haveexperience with Novitas.
They reach out, you know, adifferent way than the old
contractor used to.
They're looking for differentbenchmarks, different things on
the applications.
And so what we're starting tosee is our processing time has
(04:21):
increased a little bit here withthis contractor.
Our processing time hasincreased a little bit here with
this contractor.
That may get better as timegoes on and they get used to
their new role and their newresponsibilities.
But we are seeing someincreased processing time for
DME suppliers.
And the next point, which ispretty important for these
offices that they need to beaware of we are seeing an
(04:43):
increase in site visits,especially with the DME space.
They are coming out to checkyour door for your hours, make
sure those are posted, theymatch your NPI database, make
sure you're storing everythingcorrectly.
So with the release on some ofthe COVID restrictions, we are
seeing those CMS agents back inthe field.
Aaron Higgins (05:03):
Well, and certainly the last thing you
want to see is the CMS comingand knocking at your door.
But what can a practice expectif they do come knocking, Are
they going to get penalized ifsomething's wrong, or are they
given a window of time to fix it?
Raquel Grizzard (05:20):
Sure, If there are any deficiencies, they will
let you know what the problem is, how you can remedy that and
what your timeframe is to getthat corrected or rectified.
And so some things you staff beaware that someone may come for
(05:44):
a site visit and make sure thatyour ducks are really in a row
and that everyone isanticipating said visit.
Aaron Higgins (05:51):
Do they send a letter or do they just show up?
Raquel Grizzard (05:53):
No, you're not going to get any heads up on
this one.
They are just going to show upwhenever they want and they're
going to be looking for thosethings on a surprise visit.
Jason Crosby (06:05):
Kind of like good old Jayco visits in the hospital
setting right.
Raquel Grizzard (06:08):
It's exactly like that.
They will show up withoutwarning.
Jason Crosby (06:14):
And for those maybe that haven't experienced
it, what are some of theconsequences?
You're not prepared.
They show up, you don't havethe check boxes marked.
What usually happens after thatsite visit that folks can learn
from.
Raquel Grizzard (06:28):
So they'll let you know what's deficient, how
long you have to fix it.
So the first point here is youknow, if you're doing an initial
enrollment and you're waitingto open your doors, this is
going to delay patient care.
That's the most important partthat practices need to realize
manage your expectations andbuild in that extra time.
You know what I mean.
(06:49):
Our processing time they say,okay, you have 120 days, but if
they show up and you havedeficiencies that have to be
corrected, you're going to haveto add more time to that.
So definitely be aware thatyour processing time will be
increased for any deficiencies.
Your processing time will beincreased for any deficiencies.
(07:10):
The penalization part we're notseeing anything going on with
that right now.
Luckily we don't have anypractices that have had any real
deficits.
They're just going to ask youto either move your stock or
make sure your hours that areposted on your door match NPI.
And it's really just having youknow your T's crossed and your
I's dotted.
Jason Crosby (07:29):
Now, you mentioned before initial enrollment and
we obviously go through that alot initial enrollment,
maintenance of enrollment, chals, et cetera.
I noticed that there were somechanges along those lines in
terms of what's allowed nowgoing forward when you submit
for initial enrollment, when yousubmit for CHAL.
What are some of thoseimpactful changes?
(07:52):
Like you know, efts you're onlyallowed a certain number of
EFTs, things of that nature thatyou saw that may be impactful
to providers.
Raquel Grizzard (08:01):
So that's a good question.
Especially with a startup, youreally need to make sure that
your bank is set to go.
What we are seeing is a lot ofpractices will start up.
They get a business checkingaccount and there's no money in
it, and when Medicare goes toverify that EFT, if there is no
money in the account, your EFTwill not be processed.
(08:22):
So these are little things thatwe end up learning on the back
end when our practices, you know, get dinged for things like
that, so they are actuallyverifying your EFTs.
If you're making a change toEFT, you are now required to
delete your old EFT agreementand do a complete new one, and
(08:43):
there can be a gap in that ifyou're not careful, where you're
seeing 15 to 30 days wherepaper checks will come instead
of actual direct deposits, andso those changes can take
anywhere from 30 to 60 days toprocess when you do change EFT.
So your billers need to beaware that if payments stop
coming, you might have to startlooking for paper checks or do
(09:04):
your best to mitigate thatpatient flow if you're a very
heavy Medicare practice.
Jason Crosby (09:09):
Very important point you made there too.
So many nuances and details inthe process.
A delay or an inaccurate formcan delay payment, and I think
folks appreciate that enough.
So that's a great statement youmade there.
Aaron Higgins (09:24):
So, speaking of nuance and details, which of the
providers are able to enroll onthe 8550?
Raquel Grizzard (09:32):
So, on our 8550 applications, medicare is
currently allowing 13 providertypes, and so you have your
different flavors of doctors,right your MDs, your DOs,
dentists, podiatrists,optometrists.
We are also having mid-levelsand extenders that are able to
(09:54):
enroll in the 8550.
So your PAs, nursepractitioners, a various amount
of psych providers, midwives,social workers, and then the key
here is residents.
So we do have residentphysicians that are able to
enroll, as well as retiredphysicians who are maintaining a
license.
Jason Crosby (10:14):
Now, speaking of provider types, erin and I have
talked about in the past theruling regarding the rural
emergency hospitals that cameout last year, the designation
that many folks are looking intoYet we know many aren't
pursuing, but still of interest.
What impact has that had interms of maybe as a new provider
type that folks need to beheads up about in 2023, that REH
(10:40):
designation?
Raquel Grizzard (10:42):
Excellent.
So this is really important andthis is a great thing that
they've done to help close thegap for some of these really
rural areas where you may nothave enough care.
And so in the past, cms andother various organizations have
tried to mitigate that gap incare by offering the rural
(11:05):
physician tax credit.
You get a certain amount of yourstudent loans that are forgiven
if you will go and you willwork for two to three years in a
rural setting, because we justhave a huge gap in care out
there.
Right, you have a little teeny,tiny county hospital and you
don't have a lot of providersout in that area to serve that
population, and that populationis aging as well, and so it's
(11:25):
very important that we have carein those areas, and so Medicare
established the Rural EmergencyHospitals designation.
It's a provider type that youcan actually not only initially
enroll for, but you can convertyour current enrollment, which
is excellent If you're already afacility that somehow you now
(11:46):
meet this criteria.
Instead of doing a completelynew enrollment, you can convert
yours with a change ofinformation, which takes
significantly less time toprocess.
So they're trying to close thatgap here by providing that care
and cutting down the time ittakes to actually provide that
care for those people out there,that vulnerable market out in
(12:06):
those rural areas provide thatcare for those people out there,
that vulnerable market out inthose rural areas?
Aaron Higgins (12:11):
I know Jason and I have talked a little bit about
the REH.
At least in the last season wetalked about it.
Have you seen a rush towardsthat?
I know we're still in the veryearly days of it, but from your
perspective, have we seenhospitals or clinicians heading
that direction?
Raquel Grizzard (12:28):
No, we do service a lot of rural
facilities.
The criteria it's not widecriteria, so to be eligible to
convert you do have to be acritical access hospital or
rural hospital that did not havemore than 50 beds.
So we're talking about reallysmall facilities here.
(12:51):
You're allowed to provide youremergency services, observation,
but are prohibited providinginpatient services.
So we don't have a lot thatmeet that criteria.
But we know that they are outthere.
You know we're getting wind ofit.
People are calling to ask foradvice and help and you know how
they can go about that.
(13:11):
Do they meet that criteria?
That need is there absolutelyand I think we're going to how
they can go about that.
Do they meet that criteria?
That need is there absolutelyand I think we're going to see a
shift in facilities that domeet that criteria, definitely
moving towards that what advicewould you give to those types of
providers looking to make thatconversion from the enrollment
aspect to be best prepared?
Jason Crosby (13:30):
I know you guys have a tremendous checklist.
You kind of go through any kindof of details or hey, here's
the top three takeaways ifyou're looking to make that
conversion to best allow forthat process to take place.
Any tips for those folks?
Raquel Grizzard (13:45):
Definitely.
So.
We're going to want to makesure you allot enough time to do
that.
You know, we know that this isan emergency thing here, but
managing expectations is alwayskey.
Know that you're going to haveprocessing time.
The second part of that is itdoes cost money, right, you know
everything costs money thesedays.
(14:05):
The fee to do that initialapplication has gone up from
$631 to $688.
So making sure you have thefunds to pay for that.
And then you know, getting allof your other ducks in a row
with your paperwork.
You are going to have to uploaddocumentation with this that
(14:27):
proves that you meet thesecriteria.
And so making sure you not onlydetermine, yes, my facility
meets this criteria.
Make sure you can prove that onpaper.
So you want your time, yourmoney and you know your proof
that you meet this criteria,because you know CMS is going to
ask for all of that.
Jason Crosby (14:46):
Now kind of take a little bit of a pivot here.
We've talked about some of thebigger impacts from this ruling.
What other obstacles, barriers,challenges, however you want to
put it that you're seeing fromproviders as you take them on as
a client?
What are some of the whetherit's just education, background
(15:07):
documentation they're notproviding?
What are some of the biggestheadaches that just come right
to the top when dealing with aprovider today that they need to
learn from?
Raquel Grizzard (15:17):
The biggest issue we are faced with is
always the time managementaspect.
We realize this is real lifeand we don't always get a
multi-month heads up when aprovider is coming.
But the more time we have toprepare ahead of time and submit
that enrollment, the better.
What we're finding is, you know, we get notice that a provider
(15:39):
is hired and they're coming onand they start in two weeks.
In two weeks we can't haveenrollment processed, you know.
And so at that point yourphysician's completely out of
network and the office managersare trying to build them a
patient base.
They're scheduling patientslike crazy, trying to get them
in the door, and at that pointthere's no money coming in from
(16:00):
that.
And so you either chalk that upto that's the cost of doing
business or you try to find away to not have that happen
again, and that only.
The only solution is time here.
Right, we need more time, andthe providers don't understand
that either, and I think that'sthat's.
There's a huge gap in theeducation from when they come
out of school and they startworking.
(16:21):
They don't know how thatprocess works.
And so, you know, educating notonly the practices but those
physicians as well.
They need to become morefamiliar so that they can help
play their own part in thatprocess.
Aaron Higgins (16:33):
To become more familiar so that they can help
play their own part in thatprocess.
Ideally, how long should apractice notify you or how soon
should they be starting thatprocess?
So what behind the ears, freshout of medical school clinician
wants to start.
Are we looking at 30 days 60days, Typically?
What are we looking at 30 days,60 days, Typically?
What are we looking at?
Raquel Grizzard (16:54):
When we get fresh providers out of residency
you know most residencyprograms end at the end of June,
beginning of July we like tohave notice by March, april that
hey, we've got this person onthe hook.
We want to contract with them,Ideally four to six months,
because the legal aspect behindit is that these insurance
(17:18):
companies legally have up to 180days to process credentialing.
That's six months.
It's a huge chunk of time andthis is a necessary component.
Right, we have doctors out herepretending to be doctors who
don't have the necessarycredentials, and so that's how
this process began.
Right, we want real providers,we want good providers, and so
(17:43):
we need the time to make surethat we have safe care out there
.
Aaron Higgins (17:47):
Right.
We don't want a Frank Abagnalesituation where someone has
literally walked in off thestreet and starts providing care
to patients.
Raquel Grizzard (17:56):
It's scary and it continues to happen and I
just I can't imagine how thisactually happens, but it does.
Aaron Higgins (18:05):
That's amazing.
Okay, Jason, I know we'recoming right up on time here.
Got some more questions.
Jason Crosby (18:12):
Yeah, I guess, ra raquel, just maybe to wrap it up
, we've given some really goodadvice to folks and some updates
that have come down the pipe.
What other maybe pe tricks ofthe trade you know key takeaway
to take from this?
As a provider let's say we, youknow we have a practice
administrator, hospitaladministrator, listening what
key, what key tricks of thetrade would you give to?
Raquel Grizzard (18:35):
them.
If you are managing yourenrollment in-house, if you've
got someone in-house that'sdoing that, make sure that you
have an organized process inplace.
This is a very process-driventhing here.
Credentialing you have veryspecific steps and don't get me
wrong, the process goes off therails right.
(18:55):
Somebody doesn't receive yourcredentialing app.
It takes longer.
There's an issue, we hear you.
But by being organized andhaving a very clear process with
actual deadlines in it, you canhelp try to prevent some of
those issues.
And so the organization isreally going to be key,
especially if you have more thanone staff member doing
(19:16):
enrollment in your office.
If you have a two-person teamor anything bigger than that,
you're definitely going to needa clear, defined process for
everybody to follow and to theeveryday operations of provider
enrollment Again an areaseverely underappreciated,
undervalued.
Jason Crosby (19:36):
So we really appreciate Raquel's expertise
and time the enrollment slayerfor SHB for joining us today,
and with that we wish everybodya great rest of your day and
week.
Aaron Higgins (19:49):
Thank you for joining us, raquel, thanks for
having me.
Guys, it was great You've beenlistening to, beyond the
Stethoscope, vital Conversationswith SHP, a production of
Strategic Healthcare Partners.
Jason Crosby (20:02):
For more information about our podcast,
including back episodes, shownotes, transcripts and more,
visit our website at shplccomslash podcasts.
Aaron Higgins (20:12):
And I know you've heard it before, but please
consider rating our podcast andyour favorite podcast out.
It helps make others aware ofthe show.
Jason Crosby (20:19):
And our podcast wouldn't be possible without our
wonderful team of folks.
Aaron Higgins (20:23):
Editing and production assistance by Nyla
Weave and myself, Aaron Higgins.
Jason Crosby (20:28):
And your episode hosts are Aaron Higgins and
myself, Jason Crosby.
Aaron Higgins (20:32):
Our social media coordinator is Jeremy Miller,
our Aaron Higgins and myself,jason Crosby.
Jason Crosby (20:35):
Our social media coordinator is Jeremy Miller.
Our executive producers arealso our principals Mike
Scribner and John Crew.
Aaron Higgins (20:40):
For more from SHP , consider following us on
social media, including Facebook, twitter and LinkedIn.
Jason Crosby (20:49):
And, as always, thank you for listening and have
a great, wonderful day.
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