The Top Ten Things You Need to Know to be an Enrollment Pro

Enrollment

So, in the inimitable style of David Letterman here are the Top ten things an enrollment professional needs to know to be successful during the upcoming busy season (and any other time actually):

10. Earlybirds get the worms and the moolah. Start early! Medicare now allows you to submit an application up to 60 days prior to a provider’s start date. Dates vary by payor, so make sure you know them and submit the minute you can. Remember, it’s our money and we want it now! (Ten points for you if you can remember what TV Ad that came from). 

9. It’s all in the name: “A rose by any other name would smell as sweet,” wrote Shakespeare. Well, that may be just fine and dandy for Romeo and Juliet but not so much for us provider enrollment people. If you don’t make sure your provider’s name is the same on all documents (social security card, license, etc.) then you can expect a redo, and much time wasted. (btw, it didn’t work out that well for Romeo and Juliet either) ☺

8. It’s 5pm, do you know where your provider is? You do, OK, good. But do you know their CAQH ID? Nope? OK then go get it from them and make sure they know their login information. If they don’t have one, then you can now apply for one on their behalf (after of course giving them THAT look. You know, the one where you raise one eyebrow).

7. Absences must be explained. Yup, it’s just like high school, miss a day, gotta get a note. You must provide full provider education and work history and explain any gap since graduation. Oh, and while you’re at it remember, all dates in your provider history must be in this date format: mm/yyyy.

6. Know your Robin. You called on the batphone and nobody answered? No problem, call Robin! Get to know your provider’s Robin, a reliable contact who’s available when your provider is busy on the golf course in surgery, someone who can help you gather the information you need.

5. It’s sooo last year dahling! Don’t be caught in an enrollment faux pas using last year’s application. Check it once, check it twice, and verify that you’re using the most current application and/or process for enrollment.

4. Don’t go all blank on me! Payors love blanks, they really do. Why, because they slow things down and they get to sit on their pile of moolah for longer. So remember, when completing forms do not leave anything blank, absolutely nothing.  Use N/A if a field doesn’t apply.

3. Open those closet doors wide! And dig out all those skeletons. Make sure you get full disclosure of any malpractice or other legal stuff, even if was 20 years ago and the statute of limitations has expired.

2. Nag, Nag, Nag.  Nobody likes a Nag right? Wrong! You’re not nagging, you’re following up. Follow up early, and follow up often. The sooner you know about a potential issue the sooner you can fix it.

1. Kill them with Kindness. No, wait, that’s not right. Documentation, that’s it, documentation, Kill them with documentation. I can’t say this enough times. What are the three most important things in any payor enrollment application Documentation, Documentation, Documentation! When issues arise, and they will, you’ll be able to resolve them quickly and easily if you’ve documented everything, names dates, places… the works. Rely on memory and you’ll soon get into those “yes we did, no you didn’t” conversations.

 

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Susan Ward

About the Author
Susan Ward

At symplr, Susan Ward is the Director of the Payor Enrollment Service product line. With 20+ years’ experience in physician practice management and provider enrollment, Susan is responsible for enrollment operations and relationships with Healthcare Systems, Hospitals, Physician and provider groups focusing on increasing the efficiency of provider onboarding during acquisitions, employment or new practice start up. Her previous experience includes over nine years at Community Health Systems in Franklin, TN, where she served as the Manager of Provider Enrollment, Acquisitions and RHC Enrollment. Her strengths in organizational structure, problem solving and relationship building, as well as her background and knowledge of CMS guidelines, are an asset to Payor Enrollment Services.

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