No Surprises Act Took Effect January 1


Designed to increase billing transparency and protect consumers from unexpected healthcare bills, the federal No Surprises Act went into effect on January 1, 2022. The No Surprises Act addresses what’s known as balance billing, wherein a consumer is billed for the difference between what an out-of-network provider or service charges and what the patient’s health

17 Leadership Lessons from Bold, Brave & Brilliant


Bold, Brave & Brilliant, Team Med Global’s Leadership Success Club, wrapped up the year by reading and discussing “Radical Candor: Be a Kick-Ass Boss Without Losing Your Humanity,” by Kim Scott. While the book received mixed reviews from club members, the readings did prompt group discussions that led to 17 valuable leadership lessons. These included:

I Passed My Exam – Now What?

2021-09-30T18:44:31+00:00|Career Development|

You’ve passed your CPCS or CPMSM exam. Congratulations! But now what? You have the letters after your name – a designation that reflects your competence, your perseverance, and your commitment to our profession – but what does that mean in concrete terms? What are your next steps? The first step is to shout your accomplishment

Profiles in Leadership: Melissa Walters has a Passion to Inspire

2021-08-31T22:47:49+00:00|Profiles in Leadership|

Melissa Walters, MS, FMSP, CPCS, CPMSM, has come a long way since she was a receptionist at a West Virginia nonprofit community health system. Like many in the medical staff services profession, “I fell in love working with physicians, and being their go-to person.” At the health system, Walters was responsible for completing credentialing and

Infographic: 4 Cheerleaders that Pave the Way for Professional Success

2021-08-26T17:53:38+00:00|Career Development, Infographic|

Team Med Global knows that a helping hand can fast-track your career and your project goals. TMG's infographic illustrates how four types of cheerleaders – peers, coaches, mentors, and champions – can catapult you to success. Learn who they are, how they can help, when to find them, and how to find them. Remember that

Lessons Learned from Disaster Privileging


As medical staff professionals (MSPs), we have been flooded with articles and webinars about disaster privileging. The environment in which we navigated disaster privileging was traumatic for many of us on multiple levels. The fear for our personal safety, the sudden shift to lockdown, the isolation from our families, the shift to remote work on

Profiles in Leadership: John Pastrano’s Passion for Excellence

2021-07-31T18:30:57+00:00|Profiles in Leadership|

When John Pastrano, CPCS, CPMSM, BBA started working part-time in a local Texas hospital’s quality department, he was taking a class to learn a brand-new software program called Excel. The executive secretary in charge of credentialing had a lightbulb moment and asked Pastrano if he could leverage his software knowledge to create a quality profile.

Peers, Coaches, Mentors, Champions: Paving the Way for Success

2021-07-31T18:19:01+00:00|Career Development|

Across the arc of your career, chances are good that you’ve relied on a cheerleader, acted as a cheerleader for someone else, or both. We often group all of those who have supported us into the “mentor” bucket, and those whom we support into the “mentee” bucket. But career-related supporting roles are nuanced, and teasing

Up Your Game with the Provider Enrollment Specialist Certificate

2021-08-24T23:20:27+00:00|Payer Enrollment|

Whether your primary responsibilities are in the realm of payer enrollment or your organization is merging credentialing and payer enrollment functions, it may be time to up your game. The Provider Enrollment Specialist Certificate (PESC) demonstrates your mastery of Centers for Medicare & Medicaid Services (CMS) guidelines and regulations – the minimum requirements for enrollment

Decision-Making Frameworks: A Look Back at the Pandemic Workplace


Living and working through the COVID-19 pandemic left many of us wondering how we managed to succeed in keeping the wheels of the MSD department rolling. New daily information about the virus led to a growing understanding of its implications for our work environments and led to developing new work strategies. Leading teams, departments, and

Agreement Face Off: Delegated Credentialing vs. Shared Services


When I was a newbie, I learned a central lesson about credentialing: that to ensure compliance with the standards, the primary source verification documents I obtained for a practitioner were for my facility only, and peer review information was confidential. That changed when shared services agreements began to take hold. Over the years, four trends

Profiles in Leadership: Relationship-Builder Christine Mobley

2021-05-27T23:03:10+00:00|Profiles in Leadership|

Christine “Cris” Mobley, CPMSM, CPCS, draws a direct line from the relationships she’s built to the abundant opportunities presented to her over the course of her flourishing career. Mobley says that she and other pioneers in the medical services professional field – including Carol Cairns, Sue King, and Vicki Searcy – formed early bonds. “We’ve

Profiles in Leadership: Lifelong Learner Karen Reed, Ph.D., CPMSM

2021-04-28T23:21:53+00:00|Profiles in Leadership|

After Karen Reed took an 18-month break from the medical records field following the birth of her second child, the 23-year-old made a bold move: submitting her application to become director of medical records at Community Hospital in Lubbock, Texas. When the hospital contacted her previous employer and noted that Reed didn’t have management experience,

Know Your Strengths: Strategies for Negotiating Managed Care Contracts


The “Introduction to Health Care” textbook (Mitchell & Haroun, p. 502-503) outlines that managed care plans are designed to increase efficiency, cut costs, provide affordable healthcare, ensure quality care, and eliminate waste. In my 20-plus years of reviewing healthcare payer agreements, I have learned to successfully decipher terms and conditions, as well as negotiate on

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