Medicare Provider Enrollment 101

This session covers essential topics in provider enrollment and payer credentialing, both foundational to an organization’s revenue cycle. Yesenia Servin, CPMSM, PESC, will lead a detailed examination of these processes, emphasizing the importance of successful provider enrollment to secure in-network reimbursements. Topics will include maintaining accurate provider profiles and directories, managing revalidations, and addressing various enrollment challenges. Key insights will be shared on navigating Medicare enrollment using CMS-855 forms and the PECOS system.

• Gain a comprehensive overview of the CMS connection for Medicare compliance.
• Understand different types of Medicare applications, including Part A (Facility) and Part B (Individual and Organization).
• Explore the CMS-855 forms, including institutional, group, and reassignment forms, and how to ensure proper submission and revalidation.
• Review PECOS application sections and ensure up-to-date compliance with payer-specific requirements.

1. Medicare Basics: Parts A, B, C, and D.
2. Medicare Enrollment: CMS-855 forms (A, B, I, R, S, O).
3. Provider Enrollment Regulations: NPI, taxonomy codes, and specialty types.
4. CMS-855 Forms Analysis: Best practices for each type, revalidation, and attestation.
5. Government and Commercial Payer Requirements: Rules, network participation, and implications for revenue cycle management.
6. Identity & Access (I&A) and PECOS Navigation: Practical guidance for online enrollments.

Credentialing specialists, revenue cycle managers, billing and enrollment staff, providers, healthcare executives, insurance company representatives, and healthcare attorneys.

Speaker: Yesenia Servin

Bio:- Yesenia Servin CPMSM, PESC is an expert in credentialing and provider/payer enrollment with over 23 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. Guides the credentialing and payer enrollment structure. Thrives on training and growing administrative, credentialing and enrollment healthcare professionals.

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