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, CHCC, 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.

Many recognize David nationally for his presentations and expertise. He excels in revenue cycle management, credentialing and contracting, compliance, coding and documentation. People see David as 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, use of ancillary services and financial considerations; developing strategic plans to improve profitability and productivity. David Zetter’s activities in management and compliance include physician practices, IDTFs, hospitals, ASCs, pharmacy, DME and other facility types. This includes 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. This gave David the knowledge of what the expectations are from the payers.

David’s firm works with healthcare professional clients and facilities coast to coast. Zetter’s specialties include all areas of practice and facility management including start‐ups, buy‐ins, compensation, exit strategies, reimbursement enhancement, practice financial modeling, and governance documentation. Zetter’s firm may also assist you in policies and procedures, credentialing and contracting, HR management, compliance, chart reviews, and more.

David has helped to maximize both profitability and reimbursement of physician practices, facility, and ambulatory practices. He also re‐engineered operational and human resources, addressing coding and billing issues for providers to curtail fraud, OIG, and IRS issues.