providers

The Winter Olympics are here! If you’re like me, you’re looking forward to the excitement and thrills of international competition! I am a snowboarder so I have a personal love for winter sports and will be glued to my TV and social media feeds watching the events and keeping medal counts. There is such an inspirational culture built at the Olympics with athletes, as both teammates and competitors, pushing each other to be their best.
So why am I bringing up the Olympics? Two words: DETERMINATION & TRAINING. These exceptional athletes don’t just roll out of bed and suddenly they’re the best. They work hard – harder and smarter than anyone else. They train, plan, fail, learn, push, excel and do what it takes to be better than the competition in hopes that the long hours of preparing and executing a training plan will pay off. When the pressure mounts, these athletes will feel reassured that they’ve done enough to take their place on the podium.

Healthcare payers should have this same determined mentality when dealing with their Provider Networks. We all know that CMS is cracking down on the accuracy of Provider Networks and compliance and/or enforcement action is right around the corner. It’s time to evaluate your current processes, learn what’s worked and what hasn’t, develop an action plan and then train your team on how to support that strategy to ensure your Provider Data is up-to-date and accurate. Once you achieve that goal, it will take the same consistent effort and commitment to manage that data so it remains in compliance. Athletes have weights, cardio workouts, diet, a team of trainers and sponsor partnerships to keep them strong and competitive. Healthcare Payers have technology, experience, skilled employees and resourceful executives to keep them strong and competitive. Using solutions to monitor provider data and automatically execute provider outreach to verify data is how payers can train for their gold medal. You can’t sit idly or settle for what you’ve always done and expect to swiftly pass an audit when CMS calls. Times are changing and so should your business strategy. Make a choice to be the exceptional athlete in your industry and work hard, train, be a leader and surround yourself with a talented, knowledgeable team to help ensure success.

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Submit or Not to Submit? That is the AOR question.

Appointment of Representative, (aka the AOR) always seems to be a topic of conversation in the healthcare payer space. Every show we attend, every customer we talk with and every industry function we attend, there are intense conversations and differing opinions on what is required by CMS. Do you only submit an AOR once? Do you need to submit a […]

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New CMS Guidance

  As part of an initiative to streamline the Medicare Advantage and Prescription Drug appeals and grievance processes, CMS has consolidated Chapter 13 of the Medicare Managed Care Manual and Chapter 18 of the Prescription Drug Benefit Manual into one comprehensive guidance document. They are doing this to better align and provider a more defined, straightforward and non-repetitive understanding of […]

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Your Best Teacher Is Your Last Mistake

5…4…3… 2…1 🚀, it’s time to move forward and discover the power of you! This is the message behind the 5 Second Rule by Mel Robbins. It’s a cool, powerful self-help concept I was introduced to while listening to Mel speak recently at Hyland Software’s CommunityLive event in Nashville, TN. Embracing that concept I say 5…4…3… 2…1 it’s time to […]

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How Painful is Your Contracting Process?

Does your contracting process take forever? Can it take weeks, even months to bring a contract from creation, through negotiation and finally to execution? What causes the bottlenecks and how can they be fixed? First, let’s identify some common hurdles within the contracting process. Once identified, we can implement a contracting management solution to address those issues and reduce contracting […]

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February 9, 2018

Be an Olympic Athlete in the Work Place

The Winter Olympics are here! If you’re like me, you’re looking forward to the excitement and thrills of international competition! I am a snowboarder so I have a personal love for winter sports and will be glued to my TV and social media feeds watching the events and keeping medal counts. There is such an inspirational culture built at the […]
December 11, 2017

PAIN…a sign that change is near.

What is pain? Pain is physical suffering or discomfort caused by illness or injury. Pain motivates you to withdraw from damaging situations, to protect your body and to avoid similar experiences in the future. How many times do we have pain but ignore it? I know I have. I was running a 5K and BAM about half way through I […]
August 31, 2017

Things That Are Better Together

There are many things in this world that make us happy and bring us joy. Sometimes when those great things are combined with other wonderfully, great things they become AMAZING! Simply put…they are Better Together. Here are a few of those amazing things: Peanut butter and jelly Milk and cookies – especially chocolate chip! Netflix and your couch Danny and […]