Mastering the New 2025 Credentialing Process: Maximizing Reimbursement and Revenue New Updates

Event Materials (Key Required)

Credentialing is a critical process in healthcare administration, ensuring providers meet the necessary qualifications to practice and receive reimbursement. However, navigating the credentialing process can be complex, requiring attention to detail, compliance with various regulations, and strategic fee negotiations. In this insightful webinar, expert Michelle Stevens, CPCO, CPPM, CPB, CPC, and AAPC-approved instructor, will guide participants through the essential aspects of credentialing, from initial application to contract execution. Attendees will gain a deep understanding of the key steps involved, common roadblocks, and best practices for streamlining credentialing processes.

Additionally, Michelle will share expert strategies for effective fee negotiations to optimize payer contracts and reimbursement rates. This training is designed for administrators, billers, coders, and credentialing specialists who want to enhance their understanding and efficiency in credentialing. Through real-world case studies and expert insights, attendees will walk away with practical knowledge and actionable strategies to implement immediately.

Learning Objectives:

• Understand the importance and impact of credentialing in healthcare
• Learn the step-by-step credentialing process, including key timelines and responsibilities
• Identify common challenges in credentialing and how to overcome them
• Explore best practices for efficient credentialing and compliance
• Gain insights into fee negotiations and reimbursement strategies
• Learn how to leverage technology for improved credentialing efficiency
• Understand compliance requirements from NCQA, CMS, and The Joint Commission
• Discover strategies for maintaining ongoing compliance and avoiding pitfalls
• Analyze a real-world case study to see credentialing best practices in action
• Participate in a Q&A session to address specific credentialing concerns

Areas Covered in the Session:

• Credentialing: What & Why
• Credentialing Process
  • Obligations
    • Provider/Group
    • Credentialing Agent
    • Billing or Credentialing
  • Billing or Credentialing
    • EDI Enrollments
      • Typically, 30 Days
    • ERA/EFT
      • Typically, 14-30 Days
  • Common Roadblocks
    • Incomplete applications
    • Delays in primary source responses
    • Credentialing backlog with payers
    • Not Reading Contracts
• Best Practices for Effective Credentialing
  • Organizing Documentation Efficiently
  • Timelines and Follow-ups
  • Leveraging Technology
• Compliance in Credentialing
  • NCQA (National Committee for Quality Assurance)
  • CMS (Centers for Medicare & Medicaid Services)
  • The Joint Commission
• Fee Negotiations
  • Credentialing’s Role in Payer Contracting
  • Strategies for Negotiating Better Reimbursement Rates
  • Key Metrics to Support Negotiations
• Real-World Case Study
  • A Large Multi-Specialty Group’s Credentialing
  • Challenge
  • Solution
  • Outcome
• Closing
• Organize, Review and Submit Applications
• Follow-up and Review Contracts prior to Signing
• Strategize for Negotiating Better Reimbursement Rates
• List Payer Logo to Website

Suggested Attendees:

• Healthcare Providers
• Non-Physician Providers
• Administrators
• Billers & Coders
• Entry-Level & Experienced Credentialing Specialists
• Compliance Officers
• Revenue Cycle Professionals
• Practice Managers
• Medical Office Staff

Presenter Biography:

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Additional Information:

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact: Toll-Free No: 1-302-444-0162 Email: care@skillacquire.com

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Snippet From Our Previous Session