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.
Guest: Raquel Grizzard, Enrollment Initiatives Manager, SHP LLC
Raquel Grizzard is the Enrollment Initiatives Manager for SHP, where she has worked with Enrollment and Credentialing services for the last 9 years.
During this time, Raquel has led internal education and training initiatives, launched enrollment services, as well as work directly with clients, both provider and facilities, for enrollment needs.
Transcript
Aaron Higgins:
Welcome to Beyond the Stethoscope Vital Conversations with SHP.
Aaron Higgins:
As we take a summer break to prepare for the exciting Season 5, we’re revisiting some of our most informative episodes to keep you up to date on the latest in healthcare. In this episode from Season 2, we sat down with Raquel Grazard, SHP’s Provider Enrollment Expert. Raquel has been navigating the complexities of provider enrollment since 2014 and has witnessed many changes over the years, but none as dramatic as the 2023 CMS update. So while these changes were introduced in 2023, they continue to be highly relevant today. Raquel shares her deep expertise on a range of topics, including DME POS, CHOW filing, changes to the 8550 form and new specialists that have been added to the enrollment process. So, whether you’re navigating a new provider enrollment or are seasoned pro, Raquel’s insights and tips are invaluable for navigating these significant changes. Don’t miss this chance to revisit a critical discussion that can help you stay ahead of the curve. If you find this episode helpful, please rate and share our podcast in your favorite podcast app. It really helps the show. Thank you for tuning in, and let’s join Raquel Grizzard as she breaks down provider enrollment in this vital conversation.
Aaron Higgins:
Welcome to Beyond the Stethoscope Vital Conversations with SHP. Normally, today’s episode would be the latest headline news with myself and Jason, but with recent CMS updates about provider enrollment, we felt the need to bring you some timely information about these changes was more important. So we sat down with Raquel Grisard, SHP’s provider enrollment expert. She’s been in provider enrollment since 2014, and while she’s seen her fair share of changes, none have been dramatic as this. All at once, we discussed DME POS, chow filing, changes to the 8550, the new specialists that have been added, and much more. Are you ready for this vital conversation? Let’s get started.
Jason Crosby:
All right. Today our guest is SHP’s very own Raquel Grisard. Raquel is our Enrollment Initiatives Manager, who has been with SHP for eight years now, primarily in our provider enrollment and credentialing areas. Raquel, thanks for joining us today and welcome to the podcast.
Raquel Grizzard:
Hey guys, good to be here.
Jason Crosby:
We are going to dive into lots of good provider enrollment. Guys, good to be here. We are going to dive into lots of good provider enrollment. We often joke it’s probably the most undervalued, underappreciated aspect of provider reimbursement in particular that folks just don’t appreciate. So we’re really glad to have someone with Raquel’s expertise, also known as the enrollment slayer. All right, so let’s just jump right into it. Cms issued some significant updates provided enrollment space for 2023. Can you highlight a few of those for our audience?
Raquel Grizzard:
Yes, so we do have some exciting changes on the horizon here. First one up on the docket the DME space for enrollment. So we’ve got a contractor change with how these are processed and the process is still online through PECOS. You now have two different contractors We’ve got Novitas and we’ve got Palmetto handling. They’re splitting the country here doing these and so with that change of course, every change brings challenges, of course.
Jason Crosby:
So what’s these types of changes what’s probably the first one you’re seeing that you’re in your space today that are impacting providers, mostly on the day-to-day.
Raquel Grizzard:
So having any DME changes or initial enrollments, the process has changed a little bit. The contractor we have experience with Novitas. They reach out, you know, a different way than the old contractor used to. They’re looking for different benchmarks, different things on the applications. And so what we’re starting to see is our processing time has increased a little bit here with this contractor. Our processing time has increased a little bit here with this contractor. That may get better as time goes on and they get used to their new role and their new responsibilities. But we are seeing some increased processing time for DME suppliers. And the next point, which is pretty important for these offices that they need to be aware of we are seeing an increase in site visits, especially with the DME space. They are coming out to check your door for your hours, make sure those are posted, they match your NPI database, make sure you’re storing everything correctly. So with the release on some of the COVID restrictions, we are seeing those CMS agents back in the field.
Aaron Higgins:
Well, and certainly the last thing you want to see is the CMS coming and knocking at your door. But what can a practice expect if they do come knocking, Are they going to get penalized if something’s wrong, or are they given a window of time to fix it?
Raquel Grizzard:
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 get that corrected or rectified. And so some things you staff be aware that someone may come for a site visit and make sure that your ducks are really in a row and that everyone is anticipating said visit.
Aaron Higgins:
Do they send a letter or do they just show up?
Raquel Grizzard:
No, you’re not going to get any heads up on this one. They are just going to show up whenever they want and they’re going to be looking for those things on a surprise visit.
Jason Crosby:
Kind of like good old Jayco visits in the hospital setting right.
Raquel Grizzard:
It’s exactly like that. They will show up without warning.
Jason Crosby:
And for those maybe that haven’t experienced it, what are some of the consequences? You’re not prepared. They show up, you don’t have the check boxes marked. What usually happens after that site visit that folks can learn from.
Raquel Grizzard:
So they’ll let you know what’s deficient, how long you have to fix it. So the first point here is you know, if you’re doing an initial enrollment and you’re waiting to open your doors, this is going to delay patient care. That’s the most important part that practices need to realize manage your expectations and build in that extra time. You know what I mean. Our processing time they say, okay, you have 120 days, but if they show up and you have deficiencies that have to be corrected, you’re going to have to add more time to that. So definitely be aware that your processing time will be increased for any deficiencies. Your processing time will be increased for any deficiencies. The penalization part we’re not seeing anything going on with that right now. Luckily we don’t have any practices that have had any real deficits. They’re just going to ask you to either move your stock or make sure your hours that are posted on your door match NPI. And it’s really just having you know your T’s crossed and your I’s dotted.
Jason Crosby:
Now, you mentioned before initial enrollment and we obviously go through that a lot initial enrollment, maintenance of enrollment, chals, et cetera. I noticed that there were some changes along those lines in terms of what’s allowed now going forward when you submit for initial enrollment, when you submit for CHAL. What are some of those impactful changes? Like you know, efts you’re only allowed a certain number of EFTs, things of that nature that you saw that may be impactful to providers.
Raquel Grizzard:
So that’s a good question.
Raquel Grizzard:
Especially with a startup, you really need to make sure that your bank is set to go.
Raquel Grizzard:
What we are seeing is a lot of practices will start up. They get a business checking account and there’s no money in it, and when Medicare goes to verify that EFT, if there is no money in the account, your EFT will not be processed. So these are little things that we end up learning on the back end when our practices, you know, get dinged for things like that, so they are actually verifying your EFTs. If you’re making a change to EFT, you are now required to delete your old EFT agreement and do a complete new one, and there can be a gap in that if you’re not careful, where you’re seeing 15 to 30 days where paper checks will come instead of actual direct deposits, and so those changes can take anywhere from 30 to 60 days to process when you do change EFT. So your billers need to be aware that if payments stop coming, you might have to start looking for paper checks or do your best to mitigate that patient flow if you’re a very heavy Medicare practice.
Jason Crosby:
Very important point you made there too. So many nuances and details in the process. A delay or an inaccurate form can delay payment, and I think folks appreciate that enough. So that’s a great statement you made there.
Aaron Higgins:
So, speaking of nuance and details, which of the providers are able to enroll on the 8550?
Raquel Grizzard:
So, on our 8550 applications, medicare is currently allowing 13 provider types, and so you have your different flavors of doctors, right your MDs, your DOs, dentists, podiatrists, optometrists. We are also having mid-levels and extenders that are able to enroll in the 8550. So your PAs, nurse practitioners, a various amount of psych providers, midwives, social workers, and then the key here is residents. So we do have resident physicians that are able to enroll, as well as retired physicians who are maintaining a license.
Jason Crosby:
Now, speaking of provider types, erin and I have talked about in the past the ruling regarding the rural emergency hospitals that came out last year, the designation that many folks are looking into Yet we know many aren’t pursuing, but still of interest. What impact has that had in terms of maybe as a new provider type that folks need to be heads up about in 2023, that REH designation?
Raquel Grizzard:
Excellent.
Raquel Grizzard:
So this is really important and this is a great thing that they’ve done to help close the gap for some of these really rural areas where you may not have enough care.
Raquel Grizzard:
And so in the past, cms and other various organizations have tried to mitigate that gap in care by offering the rural physician tax credit.
Raquel Grizzard:
You get a certain amount of your student loans that are forgiven if you will go and you will work for two to three years in a rural setting, because we just have a huge gap in care out there.
Raquel Grizzard:
Right, you have a little teeny, tiny county hospital and you don’t have a lot of providers out in that area to serve that population, and that population is aging as well, and so it’s very important that we have care in those areas, and so Medicare established the Rural Emergency Hospitals designation. It’s a provider type that you can actually not only initially enroll for, but you can convert your current enrollment, which is excellent If you’re already a facility that somehow you now meet this criteria. Instead of doing a completely new enrollment, you can convert yours with a change of information, which takes significantly less time to process. So they’re trying to close that gap here by providing that care and cutting down the time it takes to actually provide that care for those people out there, that vulnerable market out in those rural areas provide that care for those people out there, that vulnerable market out in those rural areas?
Aaron Higgins:
I know Jason and I have talked a little bit about the REH. At least in the last season we talked about it. Have you seen a rush towards that? I know we’re still in the very early days of it, but from your perspective, have we seen hospitals or clinicians heading that direction?
Raquel Grizzard:
No, we do service a lot of rural facilities. The criteria it’s not wide criteria, so to be eligible to convert you do have to be a critical access hospital or rural hospital that did not have more than 50 beds. So we’re talking about really small facilities here. You’re allowed to provide your emergency services, observation, but are prohibited providing inpatient services. So we don’t have a lot that meet that criteria. But we know that they are out there. You know we’re getting wind of it. People are calling to ask for advice and help and you know how they can go about that. Do they meet that criteria? That need is there absolutely and I think we’re going to how they can go about that. Do they meet that criteria? That need is there absolutely and I think we’re going to see a shift in facilities that do meet that criteria, definitely moving towards that what advice would you give to those types of providers looking to make that conversion from the enrollment aspect to be best prepared?
Jason Crosby:
I know you guys have a tremendous checklist. You kind of go through any kind of of details or hey, here’s the top three takeaways if you’re looking to make that conversion to best allow for that process to take place. Any tips for those folks?
Raquel Grizzard:
Definitely. So. We’re going to want to make sure you allot enough time to do that. You know, we know that this is an emergency thing here, but managing expectations is always key. Know that you’re going to have processing time. The second part of that is it does cost money, right, you know everything costs money these days. The fee to do that initial application has gone up from $631 to $688. So making sure you have the funds to pay for that. And then you know, getting all of your other ducks in a row with your paperwork. You are going to have to upload documentation with this that proves that you meet these criteria. And so making sure you not only determine, yes, my facility meets this criteria. Make sure you can prove that on paper. So you want your time, your money and you know your proof that you meet this criteria, because you know CMS is going to ask for all of that.
Jason Crosby:
Now kind of take a little bit of a pivot here. We’ve talked about some of the bigger impacts from this ruling. What other obstacles, barriers, challenges, however you want to put it that you’re seeing from providers as you take them on as a client? What are some of the whether it’s just education, background documentation they’re not providing? What are some of the biggest headaches that just come right to the top when dealing with a provider today that they need to learn from?
Raquel Grizzard:
The biggest issue we are faced with is always the time management aspect. We realize this is real life and we don’t always get a multi-month heads up when a provider is coming. But the more time we have to prepare ahead of time and submit that enrollment, the better. What we’re finding is, you know, we get notice that a provider is hired and they’re coming on and they start in two weeks. In two weeks we can’t have enrollment processed, you know.
Raquel Grizzard:
And so at that point your physician’s completely out of network and the office managers are trying to build them a patient base. They’re scheduling patients like crazy, trying to get them in the door, and at that point there’s no money coming in from that. And so you either chalk that up to that’s the cost of doing business or you try to find a way to not have that happen again, and that only. The only solution is time here. Right, we need more time, and the providers don’t understand that either, and I think that’s that’s. There’s a huge gap in the education from when they come out of school and they start working. They don’t know how that process works. And so, you know, educating not only the practices but those physicians as well. They need to become more familiar so that they can help play their own part in that process.
Aaron Higgins:
To become more familiar so that they can help play their own part in that process. Ideally, how long should a practice notify you or how soon should they be starting that process? So what behind the ears, fresh out of medical school clinician wants to start. Are we looking at 30 days 60 days, Typically? What are we looking at 30 days, 60 days, Typically? What are we looking at?
Raquel Grizzard:
When we get fresh providers out of residency you know most residency programs end at the end of June, beginning of July we like to have notice by March, april that hey, we’ve got this person on the hook. We want to contract with them, Ideally four to six months, because the legal aspect behind it is that these insurance companies legally have up to 180 days to process credentialing. That’s six months. It’s a huge chunk of time and this is a necessary component. Right, we have doctors out here pretending to be doctors who don’t have the necessary credentials, and so that’s how this process began. Right, we want real providers, we want good providers, and so we need the time to make sure that we have safe care out there.
Aaron Higgins:
Right. We don’t want a Frank Abagnale situation where someone has literally walked in off the street and starts providing care to patients.
Raquel Grizzard:
It’s scary and it continues to happen and I just I can’t imagine how this actually happens, but it does.
Aaron Higgins:
That’s amazing. Okay, Jason, I know we’re coming right up on time here. Got some more questions.
Jason Crosby:
Yeah, I guess, ra raquel, just maybe to wrap it up, we’ve given some really good advice to folks and some updates that have come down the pipe. What other maybe pe tricks of the trade you know key takeaway to take from this? As a provider let’s say we, you know we have a practice administrator, hospital administrator, listening what key, what key tricks of the trade would you give to?
Raquel Grizzard:
them. If you are managing your enrollment in-house, if you’ve got someone in-house that’s doing that, make sure that you have an organized process in place. This is a very process-driven thing here. Credentialing you have very specific steps and don’t get me wrong, the process goes off the rails right. Somebody doesn’t receive your credentialing app. It takes longer. There’s an issue, we hear you. But by being organized and having a very clear process with actual deadlines in it, you can help try to prevent some of those issues. And so the organization is really going to be key, especially if you have more than one staff member doing enrollment in your office. If you have a two-person team or anything bigger than that, you’re definitely going to need a clear, defined process for everybody to follow and to the everyday operations of provider enrollment Again an area severely underappreciated, undervalued.
Jason Crosby:
So we really appreciate Raquel’s expertise and time the enrollment slayer for SHB for joining us today, and with that we wish everybody a great rest of your day and week.
Aaron Higgins:
Thank you for joining us, raquel, thanks for having me. Guys, it was great You’ve been listening to, beyond the Stethoscope, vital Conversations with SHP, a production of Strategic Healthcare Partners.
Jason Crosby:
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Aaron Higgins:
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Jason Crosby:
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Jason Crosby:
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