If you’ve worked in provider enrollment for more than five minutes, you already know: speed is everything but shortcuts come at a cost. The real challenge is moving faster and smarter. For seasoned Provider Lifecycle Professionals (PLPs), the goal isn’t just quick submissions. It’s clearing recurring provider enrollment bottlenecks that bog down even the most
The pandemic didn’t just disrupt clinical care—it reshaped the entire healthcare landscape in ways that continue to influence operations today. One of the most lasting shifts? The coverage mix. As patients moved between private insurance, Medicaid, Medicare, and exchange-based plans, provider networks and reimbursement structures adapted rapidly. For Provider Lifecycle Professionals (PLPs), these changes have
The rapid growth of telehealth and specialty practices, such as behavioral health and advanced outpatient services, has transformed the healthcare landscape. For Provider Lifecycle Professionals (PLPs), these emerging care models bring unique challenges to provider enrollment. To meet these demands, PLPs must adapt their strategies to ensure providers are enrolled efficiently and compliant with regulatory
For years, TMG has been a thought leader in the conversation surrounding the integration of provider enrollment and credentialing. Recognizing the inherent overlap between these functions, TMG has consistently highlighted the potential for greater efficiency, improved workflows, and enhanced accuracy through their alignment. While traditionally managed as separate processes, both provider enrollment and credentialing aim
As value-based care (VBC) continues to reshape healthcare, Medical Services Professionals (MSPs) play a pivotal role in ensuring that practitioners are both credentialed and enrolled effectively. These interconnected processes are foundational to participating in alternative payment models (APMs), where reimbursement hinges on delivering high-quality, coordinated, and cost-efficient care. How Credentialing and Enrollment Drive Success in
In the summer of 2011, a transformative change began in the Medical Staff Services industry, led by two thought leaders: Donna Goestenkors and Dina Solis. Their vision and dedication have since redefined the landscape of provider enrollment, a critical but often undervalued facet of revenue cycle management in healthcare. The Genesis of a Revolution The
Provider enrollment stands at the crossroads of the healthcare industry, playing an instrumental role that is often overlooked and underappreciated. It's time to shed light on the vital importance of provider enrollment specialists and acknowledge the role they play in the broader context of healthcare management. A Glimpse Into the Past Years ago, the provider
In July 2022, Team Med Global surveyed payer enrollment professionals about their job titles, the departments they work in, and those to whom they report. Here’s how they responded: 47% Credentialing Coordinator/Specialist 21% Provider Enrollment Manager/Supervisor 11% Provider Enrollment Specialist/Analyst 5% Medicare Enrollment Specialist 5% Supervisor of Credentialing 11% Other Department 21% Billing 21% Credentialing
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
Team Med Global has unveiled the first-of-its-kind Executive Provider Enrollment Professional Competency Model. According to Team Med Global President Donna Goestenkors, CPMSM®, EMSP, the model reflects the skill sets required of payer enrollment specialists who are at the top of their field. “Executive Provider Enrollment Professionals exhibit the expertise, effectiveness, and impact that deliver value
Payer enrollment is the cog that kicks off the revenue cycle. While most revenue cycle graphics indicate that client intake is the first stage in the cycle, the reality is that enrollment is the critical first phase. Payer enrollment is the process of enrolling organizations and providers into payer networks. The process varies by payer,
Team Med Global released the results of the organization’s Payer Enrollment Staffing Survey, which was designed to determine the state of payer enrollment staffing in the healthcare industry. The results were sobering, with fully 52% of respondents stating that their organization’s payer enrollment staffing levels were insufficient. According to Team Med Global President Donna Goestenkors,
On April 2, 2020, Team Med Global provided a complimentary webinar, “Stronger Together: Payer Enrollment COVID-19 FAQs.” During and after the webinar, attendees posed timely questions and shared their teams’ experiences during the pandemic. TMG team members Donna Goestenkors, CPMSM®, EMSP, Yesenia Servin, CPMSM®, and Larry DeHoyos, CPCS®, PESC, respond to attendees’ questions and comments:
The ever-changing landscape of the medical staff services profession can lead to ill-defined areas of responsibility, additional assigned responsibilities, or both. When you don’t have the training or tools to do the job well, it can feel like you’ve been thrown into the deep end of the pool without knowing how to swim. This is
When NAMSS conference attendees huddle during Team Med Global’s “Payer Enrollment Table Talk” on October 21, they’ll teach as much as they learn. “We’re hoping that MSPs and payer enrollment specialists come prepared to share their experiences,” said Donna Goestenkors, president of TMG. “Whether someone is brand new to the payer enrollment landscape or is
