2023 National Provider Enrollment Forum

August 7–8, 2023 | Oak Brook, IL

DecisionHealth is happy to announce our 2023 National Provider Enrollment Forum will be held August 7–8, in Oak Brook, Illinois! 

The 2023 National Provider Enrollment Forum delivers two days of engaging education and training to provider enrollment professionals, enrollment managers, and credentialing specialists. Experienced veterans and top industry experts offer best practices and tips for developing and sustaining successful enrollment processes. Whether you’re a newly minted professional or an experienced enrollment specialist, you won’t want to miss this opportunity to get step-by-step training and answers to your most pressing questions!

Plus, all in-person attendees receive free access to additional online-only presentations to enjoy a few weeks after they return home. 

The 2023 National Provider Enrollment Forum is bursting with innovative speakers, fresh insights, and brand-new sessions!

As always, the National Provider Enrollment Forum provides continental breakfast, lunch, snacks and beverages during networking breaks, and a networking reception, all included with registration. Attendees will also have access to an event app that includes all session materials, a session planner, and unparalleled networking with peers.
We hope to see you in Illinois! 

What’s new for 2023?

Hot topics for 2023 include:

• NCQA and URAC standards
• Billing locum tenens providers
• Office of Inspector General exclusions
• Enrolling with government and commercial payers
• Merging credentialing and enrollment
• Payer enrollment oversights
• Complying with the No Surprises Act

Other features:

• Speaker lineup featuring both new names and familiar faces
• Dedicated Q&A opportunity at the end of every session

Whether you work at a physician office, home health agency, hospital, rural health clinic, or any other setting, this is the only training event that will help you master the enrollment process and ensure timely reimbursement!

Want to expand your learning even FURTHER? Add on additional online educational opportunities!

2023’s National Provider Enrollment Forum features the opportunity to participate in additional education at home and at your own pace (see below for more information).

Provider Enrollment Boot Camp

New to provider enrollment? Our on-demand eLearning pre-conference, Provider Enrollment Boot Camp, breaks down the key steps of enrolling practitioners—it’s a can’t-miss addition for those new to the field or looking to brush up on the fundamentals. Purchase it with a registration to the National Provider Enrollment Forum and save $100!

Click here for more information about the Provider Enrollment Boot Camp.

Fundamentals of Credentialing

New to medical staff services? Fundamentals of Credentialing is an on-demand eLearning pre-conference designed to help medical staff professionals understand what is meant by credentialing, privileging, and peer review, and how these three elements work in alignment to protect patients. Purchase it with a registration to the National Provider Enrollment Forum and save $100!

Click here to learn more about Fundamentals of Credentialing

Purchase both training courses with your NPE 2023 registration and save an additional $150!

2023 National Provider Enrollment Forum

Agenda

Day 1 — Monday, August 7, 2023

7:00 a.m. – 8:00 a.m.
Registration & Continental Breakfast

8:00 a.m. – 9:00 a.m.
Mapping the Payer Enrollment Process
Donna Goestenkors, CPMSM, EMSP

Whether you’re new to payer enrollment or a seasoned veteran, it’s important to map the enrollment process. Understand the big picture of payer enrollment and then drill down to actionable steps involved in pre-enrollment and post-enrollment success.

9:10 a.m. – 10:10 a.m.
Understanding PECOS, I&A, and NPPES (wt)
David J. Zetter, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP

Join us for an introduction to the Provider Enrollment, Chain, and Ownership System (PECOS) and learn its key functions, as well as those of the Identity & Access Management System (I&A), the National Plan & Provider Enumeration System (NPPES), and National Provider Identifiers (NPI).  

10:10 a.m. – 10:40 a.m.
Networking & Refreshment Break

10:40 a.m. – 11:40 a.m.
Don't Let the No Surprises Act Catch You Off Guard
Cheryl Cisneros, RN, BSN, CPCS, CPMSM

If you contribute provider information to a health plan or have an internal health plan, compliance tasks went into effect on January 1, 2022, as part of the No Surprises Act. This session will provide background and history, share current industry updates on the No Surprises Act, and touch on how to leverage your operations to stay compliant as well as bring the knowledge gained back to your organization.

11:40 a.m. – 12:40 p.m.
Networking Lunch—Provided

12:40 p.m. – 1:40 p.m.
Critical Skills to Elevate the Role of the Provider Enrollment Professional
Mathieu Gaulin, CPMSM, CPCS Jenny Jackson, EdD, MBA, CPMSM, CPCS, FMSP

This session will provide an overview of the critical skills needed to elevate the role of the provider enrollment professional (PEP) and tools to enhance your value, visibility, and effectiveness. This session will be part participant-centered learning, part didactic, and part question & answer.

1:50 p.m. – 2:50 p.m.
Enrolling With Private/Commercial Payers (wt)
David J. Zetter, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP

Join us for an overview of the process of enrolling, contracting, and credentialing your providers with private/commercial payers. David Zetter will share best practices for completing these tasks efficiently and on time, identifying the red flags that will require special attention, and practicing ongoing maintenance.

2:50 p.m. – 3:20 p.m.
Networking & Refreshment Break

3:20 p.m. – 4:20 p.m.
Payer Enrollment Metrics
Donna Goestenkors, CPMSM, EMSP

Because payer enrollment professionals are the gatekeepers of revenue, metrics are the key to judging success. Understand the reports needed to determine whether payers are adhering to their contracts and whether internal processes are producing the desired results.

4:30 p.m. – 5:30 p.m.
Ensure You Can Bill for Your Locum Tenens Providers: Setting Yourself Up for Success
Mathieu Gaulin, CPMSM, CPCS, Matthew Littlejohn

Do you struggle with the enrollment process when bringing a new locum tenens provider on board? It doesn’t have to be difficult. In this session, attendees will learn the correct way to enroll a locums provider in order to maintain their revenue stream while giving patients access to top-notch medical care. Attendees will learn how to roadmap their unique circumstances and understand why using locums providers is a vital staffing strategy. The audience will also learn how insurance payers view locums providers so they can communicate with payers correctly, ensuring a quick and easy enrollment process.

Day 2 — Tuesday, August 8, 2023

7:00 a.m. – 8:00 a.m.
Continental Breakfast

8:00 a.m. – 9:00 a.m.
Leadership Lessons From the Cockpit
Mathieu Gaulin, CPMSM, CPCS, Jenny Jackson, EdD, MBA, CPMSM, CPCS, FMSP

This session will explore leadership lessons learned from the trenches of medical staff services, provider enrollment, and medical staff governance. Join experienced MSP/provider enrollment professional (PEP) leaders who have lived through the good, the bad, the ugly, and the triumphs of being an MSP-PEP. Get real-life tips and advice on taking your leadership journey to the next level and look toward the future of the MSP’s role. You don’t want to miss all the hot topics, including hiring, motivating, recognizing, managing, and empowering staff across the organization.

9:10 a.m. – 10:10 a.m.
What's New With NCQA and URAC Accreditation Standards?
Janet Wilson, BS, CPMSM, CPCS, FMSP

Compliance with national accreditation standards is critically important in our credentialing world. In this session, we will provide you with an overview of NCQA and URAC credentialing standards and identify the updates and compliance requirements that have been introduced in the past year.

10:10 a.m. – 10:40 a.m.
Networking & Refreshment Break

10:40 a.m. – 11:40 a.m.
What to Do With a Denial of a CMS-855 Form (wt)
Todd Selby, JD

Join us for best practices for avoiding having a CMS-855 form rejected and what to do when appealing rejections. Using case law examples, healthcare attorney Todd Selby will explain why rejections occur and what lessons you can take away from them to apply when responding to and appealing your own enrollment denials. 

11:40 a.m. – 12:40 p.m.
Networking Lunch—Provided

12:40 p.m. – 1:40 p.m.
Payer Enrollment Oversights
Donna Goestenkors, CPMSM, EMSP

When we focus on capturing waterfalls of revenue, the smaller streams can escape our attention. Uncover common oversights that leave money on the table. Learn everything from technical pointers to stakeholder strategies to tools and technologies.

1:50 p.m. – 2:50 p.m.
Exclusions 101 (wt)
Sean J. Fahey, JD

Join healthcare attorney Sean Fahey as he provides information on the Office of Inspector General’s (OIG) exclusion authority and processes. This session will review the OIG’s guidance on screening for excluded individuals and entities, examine the effect of exclusion, and discuss the self-disclosure of the employment of excluded individuals.

2:50 p.m. – 3:05 p.m.
Networking & Refreshment Break

3:05 p.m. – 4:05 p.m.
Merging Credentialing and Payer Enrollment
Donna Goestenkors, CPMSM, EMSP

Increasingly, healthcare organizations are combining payer enrollment and credentialing. This integration is occurring in environments ranging from hospital systems to managed care, often as a result of organizational mergers and acquisitions or departmental consolidations. Understand the functions of this new frontier, which include credentialing, billing, and contracting.

— Agenda subject to change —

2023 National Provider Enrollment Forum

Speakers

	Cheryl Cisneros, RN, BSN, CPCS, CPMSM, is a Consultant and Advisor.
	Sean J. Fahey, JD, helps skilled nursing facilities, assisted living facilities, home health providers, and hospice providers navigate regulatory and compliance matters. He represents clients in all areas of healthcare compliance, governance, transactions, Medicare enrollment, administrative appeals, agreements, accounts receivable, and reimbursement recovery. Fahey counsels nonprofit clients on charitable operations and governance. He frequently speaks before national and state healthcare providers and associations on assisted living and skilled nursing facility issues.
	Mathieu Gaulin, CPMSM, CPCS, has been at Boston Children’s Hospital since 2006. Gaulin worked in provider enrollment for 11 years, during which time he created and managed the centralized provider enrollment team. Currently, he is the director of health affairs, overseeing medical staff services and provider enrollment while working with the medical staff and its leaders on self-governance. To that end, he serves as the secretary of the medical staff executive committee and the administrator for the medical peer review committee, credentials committee, and bylaws review committee, among others. He served as the secretary of the Massachusetts Association of Medical Staff Services (MAMSS) for close to five years. He is currently the vice chair of the membership committee of the National Association Medical Staff Services and collaborates with them on other initiatives as a volunteer leader.
	Donna Goestenkors, CPMSM, EMSP, is a consultant, speaker, author, educator, and mentor with more than 47 years of knowledge and experience that she is privileged to share with colleagues, healthcare administrators, and medical staff leaders on issues pertinent to the medical staff services industry. Her expertise penetrates all healthcare locations and environments, including health systems; academic, community, and critical access hospitals; credentials verification organizations; payer enrollment; managed care organizations; and group and solo practice settings. Her talent in leading medical staff services professionals to their highest competence garners Goestenkors great respect among her industry colleagues.
	Jenny Jackson, EdD, MBA, CPMSM, CPCS, FMSP, is a medical service professional with 22 years of experience in managed care and provider enrollment. She is the senior director of provider enrollment and onboarding for Community Health Systems in Nashville, Tennessee. Jackson is passionate about developing other leaders and specializes in building strong teams through communication, empathy, and trust. She believes that practicing servant leadership and putting people first is fundamental to the success of every organization. Jackson is a past president of the Kentucky Association of Medical Staff Services and is an instructor for the National Association Medical Staff Services (NAMSS). She is a Certified Professional in Medical Services Management, a Certified Provider Credentialing Specialist, and a Fellow of NAMSS. She holds an MBA and an educational doctorate in organizational leadership from Western Kentucky University.
	Matthew Littlejohn is a senior provider enrollment specialist with LocumTenens.com. Starting his career at ApolloMD, he has amassed seven years of experience in the provider enrollment field. During his time at ApolloMD, he was responsible for enrolling clinicians to ensure the company was able to bill correctly and recuperate revenue on services rendered. Since joining LocumTenens.com five years ago, he has played a critical role in the launch and growth of the provider enrollment team. Currently, Littlejohn and the provider enrollment team advise clients of the process for enrolling locums clinicians and assist them with their enrollment needs related to clinician onboarding. Seeing the impact enrollment has on all stakeholders, he has found a passion for educating others on provider enrollment and sharing his expertise across the industry.
	Todd Selby, JD, focuses on regulatory and compliance issues affecting all healthcare providers with an emphasis on long-term care, home health, and hospice providers. His practice is concentrated in the areas of licensure, certification, compliance, and reimbursement at the local, state, and federal levels. He also assists clients with Medicare and Medicaid enrollment and participation requirements and serves as a liaison between clients and regulatory agencies. Selby has extensive knowledge and experience in these areas and is recognized nationally by long-term care, home health, and hospice clients for his skills and proficiency. In addition to his representation of this unique client base, he frequently speaks before national and state healthcare providers and associations.
	Janet Wilson, BS, CPMSM, CPCS, FMSP, began her career in healthcare in 1986, and over the past 37 years she has managed and directed medical staff and credentialing services in independent and multihospital systems, ambulatory care centers, physician groups, health plans (delegated credentialing), and independent and system credentials verification organizations. She served for three years on the board of directors of the National Association Medical Staff Services (NAMSS). She also served on the board of directors of the Texas Society for Medical Services Specialists and served as its president during her six-year tenure. She has served as an independent educator and consultant in the healthcare industry for 15 years and has spoken at numerous state and national conferences. In addition, she has served as faculty for Edge-U-Cate, LLC, and taught certification-focused study programs and other industry-related programs. Wilson also served as a NAMSS instructor for 10 years and has participated in the development of education programs related to credentialing and privileging, managed care, leadership, and professional development
	David J. Zetter, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP, is founder and president of Zetter HealthCare LLC. He and his firm have provided practice management consulting services to medical and dental practices, facilities, and organizations for more than 25 years. Zetter is a nationally recognized enrollment expert and speaker, and CMS regularly solicits his feedback in their PECOS and compliance user focus groups. He is the current president of the National Society of Certified Healthcare Business Consultants and is a Certified Healthcare Business Consultant (CHBC). He is also a Certified Professional Coder (CPC) for physician practices, hospitals, and facilities, and a Certified Healthcare Compliance Consultant (CHCC). Zetter is a member of the American Health Lawyers Association, the Medical Group Management Association, and the Healthcare Financial Management Association. His firm supports client practices and facilities in all 50 states.

2023 National Provider Enrollment Forum

Location

Hilton Chicago/Oak Brook Hills Resort & Conference Center
3500 Midwest Road
Oak Brook, IL 60523

Self-parking is complimentary for conference attendees.

Room rate: $169/night plus taxes and fees
Hotel cut-off date: Friday, July 14, 2023. Hotel rooms may sell out earlier than the cut-off date, so book early!
Reservation Center: 630-850-5555 and referencing the National Provider Enrollment Forum room block
Reservations URL: Coming soon!
Hotel website: https://www.hilton.com/en/hotels/chibhhh-hilton-chicago-oak-brook-hills-resort-and-conference-center/

Reservations
Simplify Compliance/DecisionHealth has no affiliation with any third-party companies or travel assistance providers. Rooms should be booked directly with the event hotel using the official information provided on the website and in the brochure.

2023 National Provider Enrollment Forum

Sponsors

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2023 National Provider Enrollment Forum

Continuing Education

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