Comply with New Provider Directory Validation Rules, Avoid Fines

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New government regulations make YOU responsible for the accuracy of your in-network payer directory listings – every 90 days, or risk having your payer contracts terminated.

Failure to comply can mean that you’ve committed fraud, the payer will be fined, and those fines passed on to you. Plus, any patient who relies on incorrect provider information can legally come to you for reimbursement of differences between in and out-of-network services.

This issue is fraught with operational, legal and financial challenges — but fortunately, you don’t have to figure it out all on your own…

This is where practice management expert, David J. Zetter, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, can help. During his online training, David will provide you with actionable step-by-step tactics to help you more easily and compliantly create and manage your payer provider directory listings, so you don’t violate these new rules stipulated in the No Surprises Act.

Here are just a few of the questions you’ll get answered to by attending this 60-minute online training:

  • What are your responsibilities if a provider leaves your practice or takes a leave of absence?
  • What if the payer fails to send out an attestation reminder?
  • Are you required to have processes in place to stay on top of your directory listing?
  • What is the best way to fix a directory error outside of attestation timelines?
  • How can you utilize your CAQH listing to reduce your compliance risk?
  • When are you required to notify the payer of schedule changes (either location or time)?
  • What format should you use to notify payers of changes?
  • Do the rules change if nonphysician providers bill under physician NPIs?
  • How should new provider services be billed if their directory listing isn’t finalized?
  • What documentation is required when providers change their name?
  • When a provider leaves your practice, when must you notify the payer?
  • And much more!

IMPORTANT: You are required to comply with these new provider directory creation and validation rules implemented this year by the No Suprises Act. This is true regardless of your practices size, location, or specialty. Everyone is required to comply.

Even an innocent mistake during your provider directory creation or attestation process can have serious implications for your practice. You must get it right the first time to avoid difficult-to-fix errors that will significantly delay reimbursement and can lead to fines, contract terminations, and patient frustration.

By attending this expert-led provider directory training, you’ll receive proven, step-by-step tactics that you can put into action immediately. This online training will help you overcome the confusion of these new rules and keep your payer reimbursement flowing. Don’t wait, sign up today!

Meet Your Expert

David J. Zetter
PHR, SHRM-CP, CHC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHPFounder & President, Zetter Healthcare Management Consultants

David Zetter is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 30 years of operational and healthcare experience. David is nationally recognized for his presentations and expertise. He is well versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered an expert on Medicare, not only by his clients, but his consultant colleagues across the country. He has evaluated existing ambulatory care facilities and practices with respect to patient flow, operations, marketing, fee structures, use of ancillary services and financial considerations; developing strategic plans to improve profitability and productivity. His activities in management and compliance include physician practices, IDTFs, hospitals, ASCs, pharmacy, DME and other facility types, including coding and broad‐based regulatory issues. David has also conducted chart audits on behalf of Medicare contractors and Blue Cross/Blue Shield early in his career, so he has knowledge of what the expectations are from the payers.

David’s firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management including start‐ups, buy‐ins, compensation, exit strategies, reimbursement enhancement, practice financial modeling, governance documentation, policy and procedure development and implementation, credentialing and contracting, human resources staffing and management, compliance, coding and chart reviews, physician education and many other areas. David has helped to maximize both profitability and reimbursement of physician practices, facility and ambulatory practices, re‐engineered operational and human resources, and addressed coding and billing issues for providers to curtail fraud, abuse, kickback, OIG, and IRS issues. He is also an original member of CMS’ PECOS Power User Group, CMS Compliance Focus Group and MIPS Design Lean Work Group which provides feedback and recommendations to Medicare’s Center for Program Integrity and Provider Enrollment Operations Group on design and improvements to the PECOS enrollment environment, as well as, NPPES and MIPS and conducts beta testing of the EHR/HITECH user interfaces and environments at the request of the Office of e‐Health Standards & Services Director. David is also on the CMS contracted team awarded the PECOS 2.0 contract to rebuild PECOS from the ground up.

David has conducted practice management, human resource, coding and compliance education and seminars in many states over the past twenty‐five years. David speaks often on a variety of practice management subjects at hospital residency programs, the National Society for Certified Healthcare Business Consultants, the Medical Management Group Association, the American Academy of Professional Coders, AHIMA, Florida Institute of Certified Public Accountants, Florida Medical Society, many other venues and is often called upon by the MGMA, HFMA, Decision Health, Part B News, Part B Insider, and many others, to conduct audio conferences and webinars. He has been published in Medical Economics and interviewed and quoted in many publications including Report on Patient Privacy and Report on Medicare Compliance.

David is a past President and current Executive Board Member of the National Society of Certified Healthcare Business Consultants. He has served on the Education Committee for more than twenty years and is a Certified Healthcare Business Consultant. He is a member of the Society for Human Resource Management and is a past Professional Development Chair and past Vice President of Human Resource Professionals of Central PA. David is also a past board member of the Central PA affiliate chapter of the American Academy of Professional Coders and is certified as a Professional Coder for physician practices, hospitals, and facilities. David is also a Certified Compliance Consultant and Officer. David is also a member of the American Health Lawyers Association, the Medical Group Management Association, and the Healthcare Financial Management Association.

David advises on and publishes operations policies and procedures manuals, employee handbooks, compliance manuals, HIPAA and OSHA and has published articles in numerous healthcare and human resource related magazines on subjects like coding and compliance, interviewing, recruitment, evaluations and disciplinary processes.