V2V Management Solutions

Value-based Management for Health Care Providers

208.717.3940

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      • Michelle Wier, MBA, CMPE
        Founder
      • Debra Wiggs, FACMPE
        Founder
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        Founder
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      • Pat Hupman
        FACMPE, Transformationist
      • Tiffany Todd
        Transformationist
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        PESC – Transformationist
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        Tranformationist
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        Practice Partner
      • Heidi Johnson
        Practice Partner
      • Regina Levison
        Practice Partner
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Payer Enrollment in 2023

Effective physician onboarding is a process that requires an organized approach to the many details that play an essential role in your practice’s financial success. Front and center in that process is provider enrollment in payer plans. Accurate and timely provider enrollment is the first step and is key to successful revenue cycle processes. Initial enrollment and recredentialling with payers is an annual process for most practices and it remains an ever-evolving landscape. Many payers change forms and needed information over time. Missing a key step or required piece of information may put your revenue cycle efforts at risk. 2023 is no different, as CMS is making changes in the PECOS enrollment process. Provided below this article is a link to a YouTube video published by the CMHSHHSgov channel explaining PECOS 2.0 changes.

As a reminder we have provided the below list of key steps to keep in mind as you navigate this process.

  • First and foremost, the beginning of the enrollment process is to verify the existing or establish a new entity with regard to each group expansion, merger, service line addition.
  • Don’t let a lapse or missing documents be the cause for an enrollment failure.
  • When to start? The day a decision is made to grow or make a change, where a provider is identified with a start date.
  • Don’t let outdated or missing documents hold up your process. Verify the availability of each required document at the beginning. There is no time for delays.
  • Be sure that the provider has documentation and a timeline that includes all years of clinical practice activity.
  • Documents will need to be accessed, sometimes more than once in the process, so everything should available electronically.
  • Never assume that documents or processes followed in the past are relevant in the present. Get updated process information for each enrollment directly from a website or resource within the payer organization.
  • Get any information from providers that have experienced reportable actions with organizations in the past. These events could add months to an enrollment process.
  • Enrollment processes can change by payer, by state, and by service line.
  • Use a review process before anything is sent to a payer. That redundancy in the process can potentially save months of frustration.
  • The process ends when the payers recognize an active network status, and claims are processed by EFT directly to your bank account.

The above are just a few of the reasons that credentialing services are highly advised. As in our case, our team is focusing on payer enrollment every day, have familiarity with the payer processes, and use technology to organize our provider data for present and future access for all validation processes.


*PECOS 2.0 will make the Medicare enrollment and revalidation processes faster and more efficient. The new experience is expected to launch in Summer of 2023.

https://www.youtube.com/watch?v=P9ee_yWrsGU

Disclaimer: V2V Management Solutions is a healthcare consulting firm. We are not licensed attorney’s or certified public accountants. This guide is not intended to replace legal or financial advice from your trusted resources. Before acting on any information provided check with the appropriate legal or financial team. This situation is a constantly evolving landscape be sure to research for most current information.The following content consists of key takeaways on information published in the above referenced articles, facts sheets, and our personal/professional experiences in financial management throughout a crisis.

ONBOARDING Advantage℠
Payer Enrollment Services


Our enrollment team brings over 15 years of multi-state experience, serving hundreds of health care professionals nationwide. Our expertise allows us to ask the right questions to anticipate the activities required to optimize the enrollment workflow and assume a lead role in completing and facilitating each process.

Our payer enrollment services include full spectrum support services positioning you for revenue cycle success. A customized checklist is created for each provider focusing on the required timeline and services provided to each applicant, allowing you total confidence that all your bases are covered.

Our experience includes:

  • Independent practices of all sizes
  • Hospital affiliated groups, including delegated roster management
  • Rural Health Clinics
  • Federally Qualified Health Center
  • Independent Testing Facilities
  • Hospital Based Providers
  • Mobile Services
  • Behavioral Health Groups

Please note our rate structure has new options providing for an application-based fee structure.

New Group Applications from $250*
New Provider Applications from $150*
Annual all-inclusive fees for follow-up, maintenance, and revalidations $300/provider

*Some Payers and/or specialists have additional requirements.

 

V2V is here to help


For Rapid Response Contact us at:
Irv Barnett, Founder: [email protected]   208-717-3941
Michelle Wier, Founder: [email protected]  208-717-3943

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“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“Michelle Wier, CMPE, worked with our EMS program for a year, providing interim financial management at a crucial time for our hospital district based agency. Her exemplary work included budget and tool development, redesign of our financial statements, and a compensation analysis for all EMS positions. She helped provide crucial accountability for our internal accounting systems, contract negotiation support and a streamlining of our in house processes and reporting structures. I highly recommend her work product and greatly appreciate her astuteness and work ethic.”

J. Michael Edwards, DDS, MD, FACS – Commissioner, San Juan County Public Hospital District #1 San Juan Island EMS and MedEvac

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“With excitement and enthusiasm I announce the transition of Wier Management Solutions to V2V Management Solutions. I’m honored to partner with some of the industry’s best “Transformationists,” who will assist our clients in realizing and enhancing the value within their organizations.”

Michelle Wier – President, Wier Management Solutions, Inc.

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

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V2V Management Solutions • 208.717.3940 Regional Offices: Idaho
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