provider enrollment educationIn 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 journey began with a simple yet profound question from Donna to Dina: “What exactly is provider enrollment?” This conversation marked the inception of a movement that would bring provider enrollment from the background to the forefront of industry awareness.

Bridging Knowledge Gaps

Donna and Dina recognized early on that while credentialing and provider enrollment were separate functions, their interdependence was crucial. Credentialing involves verifying a provider’s qualifications and competence, while provider enrollment involves achieving a provider’s inclusion into insurance payer networks for reimbursement for services rendered. While many in the industry saw these as distinct, Donna and Dina foresaw the potential for integration, contending that efficiencies and cost savings could be attained by combining these roles in certain business models.

Advancing Through Education and Collaboration

The duo’s commitment to education has been a cornerstone of their approach. Quickly realizing that there was a severe lack of provider enrollment instructional resources for MSPs, they pioneered the development of educational webinars, infographics, and training materials. Soon, the demand by MSPs for more detailed and specialized information emerged, spurring Donna and Dina to offer educational programs at in-person conferences. Since then, Donna and Dina, along with TMG Provider Enrollment team leads and industry experts Yesenia Servin and Larry DeHoyos, have played a key role in presenting provider enrollment topics at NAMSS and other industry-related conferences, seminars, and trainings, challenging traditional perceptions and pushing for broader understanding. Today, TMG offers the first and only Provider Enrollment Prime webinar series, live provider enrollment Q&A sessions, a social media community, and even the Executive Provider Enrollment Professional (EPEP) certification program that allows MSPs to distinguish their level of competency within the industry.

Innovating Through Experience

Dina’s decades of hands-on experience in provider enrollment, creating standard operating procedures for enrollments, and managing complex service locations provided practical insights into the challenges and intricacies of provider enrollment. Donna, through her extensive network and 40+ years of industry experience, facilitated knowledge exchange and mutual learning.

Impact and Legacy

Their impact has been profound:

Community: Where there was once a sense of disconnect and detachment, Donna and Dina have shaped an entire community of provider enrollment professionals who network, promote inclusion, and enhance knowledge by sharing enrollment challenges.

Specialized Roles: Provider enrollment now boasts specific, dedicated roles, reflecting its complexity and importance, including the notable distinction of inclusion as a service line in Medical Staff Services.

Strategic Importance: A greater value is placed on provider enrollment’s impact and role in healthcare organizational finance strategy, evidenced by the inclusion of provider enrollment subject matter experts in executive teams and boards.

Educational Outreach: Their partnership with state medical associations and companies like Medkinetics, Symplr, Intellisoft, and DecisionHealth has enabled widespread education through webinars and national conferences, drawing thousands of attendees, positive accolades, and national recognition as provider enrollment thought leaders.

Innovative Formats: From webinars and lectures to panels and roundtable discussions, they’ve continuously evolved the format of their educational offerings to maximize engagement and learning.

Future Directions: The duo’s vision extends to writing a provider enrollment book and working to standardize provider enrollment practices across health plans. Their dream of a dedicated provider enrollment conference is also on the horizon.

Donna Goestenkors and Dina Solis have not just been participants in the evolution of provider enrollment education; they have been its architects. Their journey from 2011 to the present exemplifies how vision, collaboration, and relentless pursuit of education can transform an industry. The legacy they are building continues to open doors of opportunity and paves the way for future generations in the field of Medical Staff Services.