MedTrainer

FEBRUARY 5, 2024

In this blog, we’ll discuss the two processes and key differences between provider enrollment and credentialing. Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. So, what is the difference between provider enrollment and credentialing?

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Licensing Governance Compliance Fraud 52

Verisys

AUGUST 31, 2023

Here are seven red flags to look out for and the reasons why: Incomplete or inconsistent application: Missing or conflicting data regarding education, training, work history, licensure, or malpractice history might indicate false information or attempts to conceal relevant details.

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Malpractice Fraud Medicaid Medicaid 52

Provider Trust

JULY 8, 2022

Department of Health and Human Services (HHS) and contains medical malpractice payments and adverse action reports on healthcare professionals. Below are the significant laws and regulations that govern NPDB operations: NPDB Regulations. For more information, view the webinar on demand. Healthcare Legislation & Regulations.

Licensing 52

Licensing Malpractice Fraud Medicaid 52

Verisys

AUGUST 17, 2023

Mitigating liability and legal risks Malpractice claims and legal disputes can financially and emotionally drain healthcare providers and organizations. Medical staff service teams typically check at least half a dozen primary sources to properly verify a healthcare provider’s credentials.

Malpractice 52

Malpractice Licensing Compliance Medicaid 52

MedTrainer

JULY 28, 2023

While learning of an inspection can cause alarm, oftentimes it’s a routine occurrence required by the federal government to ensure the overall quality and delivery of healthcare services. This ensures that medical facilities are not engaging in malpractice and following program rules and regulations.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Verisys

DECEMBER 5, 2023

An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. The policy issuer for malpractice insurance verifies insurance coverage.

Governance 52

Governance Licensing Malpractice Medicaid 52

MedTrainer

FEBRUARY 29, 2024

In this blog, we’ll review insurance credentialing and the steps to getting credentialed with insurance companies. The insurance credentialing process is when a healthcare organization registers a provider through specific insurance carriers or government payers. There are several steps to this time-consuming process.

Malpractice 52

Malpractice Licensing Nurses Governance 52

MedTrainer

APRIL 27, 2024

In this blog, we’ll look at the unique aspects of HRSA credentialing requirements and why many community health centers, FQHCs , and look-alikes use credentialing software to prepare for a successful on-site visit. Government-issued picture identification. Keeping these straight in a very fast-paced healthcare environment is tough!

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Licensing Compliance Malpractice Governance 52

MedTrainer

MAY 6, 2024

This blog will highlight how credentialers can navigate Aetna provider enrollment. As a healthcare organization, you understand the importance of working with insurance payers to ensure smooth and timely reimbursement. The challenge is meeting each payer’s unique provider credentialing and enrollment process requirements.

Licensing 52

Licensing Malpractice Health Insurance Medicaid 52

MedTrainer

MARCH 23, 2024

Inability to receive reimbursement: Insurance companies and government payers require medical credentialing to authenticate a provider’s qualifications to practice. Without verifying qualifications, healthcare organizations won’t receive reimbursement for patient care services from insurance or government payers.

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Licensing Malpractice Governance Doctors 52

MedTrainer

MARCH 12, 2024

To underline the significance and complexity of this system, we will explore what are reportable events in healthcare, the regulatory requirements that govern them, the types of reportable events, and the importance of proper reporting. Each state has its own set of laws and regulations dictating what must be reported and when.

Compliance 52

Compliance Malpractice Governance Public Health 52

Physician Credentialing Company

JANUARY 16, 2025

Credentialing in healthcare is a complex process of reviewing and evaluating the credibility of healthcare practitioners to fit the standard set by the government. Red Flags for Credentialing in Healthcare It is important for quality and compliance to identify the early roots of these issues during the credentialing process.

Malpractice 52

Malpractice Compliance Licensing Regulatory Compliance 52

MedTrainer

AUGUST 2, 2023

It involves collecting and reviewing information such as education, training, licensure, certifications, work history, malpractice history, and references — all in pursuit of verifying that providers are who they say they are and qualified to deliver legitimate, safe, and ethical care.

Malpractice 52

Malpractice Due Diligence Compliance Licensing 52

Physician Credentialing Company

JANUARY 14, 2025

Malpractice Insurance: Address liability coverage. Malpractice Claims: Lawsuit history or any kind of settlement. Final Approval: Governing board gives favors (2-4 weeks). Duration and Termination: Indicate the contract's time period and the terms of extension or cancellation.

Licensing 52

Licensing Malpractice Regulatory Compliance Compliance 52

MedTrainer

MARCH 14, 2024

Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority. Whether it’s government regulation or healthcare facility requirements is a matter. Upon completion and approval, the provider can begin billing for medical services.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

MedTrainer

DECEMBER 2, 2024

Diversification of Payer Sources FQHCs are not limited to government funding through Medicaid and Medicare. Familiarize yourself with any payer-specific requirements such as proof of malpractice insurance, state-approved alternatives, and specific forms like the special needs survey or disclosure of ownership statement.

Licensing 52

Licensing Malpractice Compliance Medicaid 52

MedTrainer

NOVEMBER 27, 2023

Ohio Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Ohio Department of Health (ODH) is key to safeguarding and enhancing the health of Ohio residents. Additionally, providers must submit a minimum five-year work history for initial credentialing.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Med Law Blog

MAY 1, 2023

Please note that the potential for ulterior financial motives does not automatically presume that the intent is somehow suspect, in the same way that potential medical malpractice concerns does not legitimately question the clinical motives of all other providers.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

MedTrainer

AUGUST 5, 2024

This engagement helps leaders make well-informed and balanced decisions, contributing to better governance and oversight. Fostering Board Engagement and Effective Decision-Making Credentialing and privileging processes require thoughtful discussions and collaboration among board members, including physicians and lay trustees.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Physician Credentialing Company

OCTOBER 25, 2024

Session notes should be formed as per rules and regulations set by the government and payers. The separation of these codes ensures that providers do not bill less in an attempt to increase their customer base or bill higher to put themselves in challenges of an audit and malpractice. Also read our blog to know about the 90833 CPT.

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Licensing Medical Billing Telemedicine Medicare 52

MedTrainer

FEBRUARY 13, 2022

Evidence of continual malpractice coverage. Upon completion, the information is provided to a governing board within the institution to give the final approval for the provider to begin practicing. Board certification if applicable. Work history. Personal immunization records. Professional and personal references. CAQH enrollment.

Licensing 40

Licensing Malpractice Governance Compliance 40

Physician Credentialing Company

JANUARY 23, 2025

Automation software makes it easier by sanitizing licenses, certifications, and malpractice records automatically with the government in order to avoid misprints and expedite verification. Verifying credentials of healthcare providers manually can take time.

Licensing 52

Licensing Compliance Malpractice Hospitals 52

Bill of Health

OCTOBER 14, 2022

In this blog post, I will describe why this represents a lost opportunity. public health infrastructure nor American political culture support the kind of muscular central government mandates that have characterized the COVID-19 policies of many other countries. Neither the U.S.

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COVID-19 Public Health Elder Care Governance 325

Verisys

MARCH 30, 2023

Healthcare organizations must regularly check practitioners’ qualifications and license status to comply with regulations and to ensure payment from private and government agencies like Medicare and Medicaid. Medical credentialing , unfortunately, isn’t one-and-done at the time of hire. What are the requirements for medical credentialing?

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Hall Render

MARCH 5, 2024

Because the Act allows for the collection of punitive damages, for which there is no limit under Alabama law, damages may be substantially higher than those that would be awarded in a traditional malpractice case. Hall Render blog posts and articles are intended for informational purposes only. If you have questions regarding LePage v.

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Malpractice Hospitals Governance 75

Hall Render

APRIL 14, 2023

NATIONAL 94% of Organizations Experienced a Cyberattack in 2022 AHA blog: Strengthening crisis management in rural health care Biden signs bill ending Covid-19 national emergency Cancer drug shortages are creating dire circumstances for some patients CMS Releases FY24 IPPS Proposed Rule, Seeks to Boost Rates by 2.8%

Nursing Homes 40

Nursing Homes US Department of Health and Human Services COVID-19 Nurses 40

Bill of Health

OCTOBER 17, 2022

Other increasingly viable employee lawsuits are ADA disability discrimination or Title VII claims , possibly bolstered by federal government guidance from the U.S. Ek and allowed to stand by the state supreme court in 2022). Department of Health and Human Services and the U.S. Equal Employment Opportunity Commission.

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COVID-19 Nursing Homes Nurses Public Health 237

Drug & Device Law

JANUARY 30, 2024

And it all arrives in the form of a medical malpractice case. As we have discussed several times before in this blog, the PREP Act provides that a “covered person” shall be immune from liability with respect to all claims involving the use of a “covered countermeasure.” section 1367(c) to remand the case to state court. So far so good.

Malpractice 89

Malpractice COVID-19 Vaccine COVID-19 Doctors 89

Med League

OCTOBER 5, 2023

This blog post delves into the factors contributing to this crisis and highlights the urgent need for accountability and reform. Despite the high death toll within these facilities, there was a reluctance to accept responsibility at all levels of leadership, from the state government to the facility administrators.

Nursing Homes 40

Nursing Homes Nurses COVID-19 Malpractice 40

Drug & Device Law

MAY 25, 2023

For several years, we have blogged about the controversy over whether the American Law Institute (“ALI”) should put its Restatement Third of Torts imprimatur on no-injury medical monitoring. There was an insufficient time to discuss the Torts: Medical Malpractice draft. Here’s the latest update, as that effort nears culmination.

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Informed Consent Malpractice Governance 59

Drug & Device Law

APRIL 10, 2023

That’s why this defense oriented blog has inveighed against claims solely for “ medical monitoring ” ever since it was founded. Plaquemines Parish Government , 982 So.2d Prosser & P. Keeton, Prosser & Keeton on the Law of Torts , at 165 (5th ed. 1515, 1523 (D. Kentucky : Wood v. Wyeth-Ayerst Laboratories , 82 S.W.3d

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Malpractice Governance Hospitals 59