Verisys

APRIL 3, 2025

Compliance Penalties Regulatory agencies like the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission enforce strict medical credentialing standards to ensure healthcare providers meet necessary qualifications and maintain patient safety.

US Department of Health and Human Services 52

US Department of Health and Human Services Licensing Compliance Malpractice 52

MedTrainer

FEBRUARY 27, 2025

OIG exclusion list monitoring is vital in maintaining compliance with Centers for Medicare & Medicaid Services (CMS) regulations, as well as National Committee for Quality Assurance (NCQA) credentialing standards , among other federal healthcare provisions. We wouldnt either.

Compliance 52

Compliance Malpractice Fraud Licensing 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

MedTrainer

MAY 7, 2024

This blog will highlight how credentialers can navigate UnitedHealthcare provider enrollment. Completing UnitedHealthcare provider enrollment is no different. Credentialers understand the importance of working with insurance payers to ensure smooth and timely reimbursement. It’s a challenge.

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52

Verisys

FEBRUARY 3, 2025

This includes verifying qualifications, submitting proof of malpractice insurance , and ensuring compliance with all healthcare regulatory compliance standards. court documents, dismissals) for all malpractice/disciplinary actions OR completion of appropriate explanation form (if applicable).

Malpractice 52

Malpractice Regulatory Compliance Licensing Compliance 52

Physician Credentialing Company

DECEMBER 20, 2024

It acts as a shield against malpractice claims under the False Claim Act. Medicare and Medicaid allow non-credentialed providers to get reimbursement but under strict rules. It takes 2-3 months for credentialing, and new recruits cant just sit and wait during this time. Each payer has its own policies and rules for billing.

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 52

Physician Credentialing Company

SEPTEMBER 19, 2024

If something goes wrong while providing medical services, providers do not have any legal protection and have to face malpractice claims. You can also see Medicaid covered patients but each state has different rules regarding the retro-billing for Medicaid. Liability issues can even result in the termination of their license.

Malpractice 52

Malpractice Medicare Medicare Medicaid 52

MedTrainer

MAY 30, 2024

They also conduct background checks, which require calling law enforcement and other regulatory agencies for criminal records and malpractice history. Traditionally, credentialers call the appropriate entities to verify transcripts, licenses, etc.

Licensing 52

Licensing Malpractice Medicare Medicare 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. The best practice for finding exclusions and sanctions in addition to referencing the NDPB is to search the OIG LEIE and SAM.gov websites and all available state Medicaid exclusion lists.

Licensing 52

Licensing Malpractice Fraud Medicaid 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.

Malpractice 52

Malpractice Fraud Medicaid Medicaid 52

MedTrainer

MAY 15, 2024

Annual Updates Most of the New York organizations that my team works with ask for NPDB (National Practitioner Data Bank) reports, background checks, malpractice insurance information, and more. However eMedNY, the New York Medicaid program , asks for a paper application that needs to be sent via postal mail. Background Checks.

Malpractice 52

Malpractice Medicaid Medicaid Licensing 52

Verisys

NOVEMBER 30, 2023

Credentialing lapses can expose a healthcare organization to malpractice suits and accreditation problems. This creates the potential for negative patient outcomes, which can lead to expensive malpractice lawsuits. Thorough and ongoing physician screening is critical to avoid costly negligent credentialing and malpractice claims.

Malpractice 52

Malpractice Licensing Due Diligence Hospitals 52

MedTrainer

MAY 15, 2024

Florida Medicaid Portal The Florida Medicaid Web Portal is very specific and if you aren’t familiar with submitting the documentation, it is easy to make a wrong turn. Providers must first submit their Medicaid enrollment application and receive the Application Tracking Number (ATN) before they can access the clearinghouse.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Physician Credentialing Company

NOVEMBER 21, 2024

Steps for Insurance Credentialing We are just mentioning the useful steps for Credentialing Process in this blog, because there already a well-written and informative blog as well as visual flow chart for credentialing process so you can check them out to have a perfect idea. This signifies professionalism and credibility.

Licensing 52

Licensing Malpractice Medicaid 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

Verisys

JULY 20, 2023

This creates the potential for adverse patient outcomes, leading to expensive malpractice lawsuits. Thorough and ongoing provider screening is critical to avoid costly negligent credentialing and malpractice claims. Mistake No. Mistake No.

Due Diligence 52

Due Diligence Malpractice Licensing Hospitals 52

MedTrainer

MAY 29, 2024

No Medicaid Identification Numbers As of September 1, 2021 , Texas stopped assigning Medicaid identification numbers, formerly known as a “TPI number.” If the provider will be enrolling with Medicare and the Texas Medicaid program , you’ll also want to set up the Provider Enrollment and Management System (PEMS) profile.

Medicaid 52

Medicaid Medicaid Malpractice Licensing 52

MedTrainer

SEPTEMBER 5, 2024

Typical organizations that may query the NPDB are: Hospitals Professional healthcare organizations or societies Boards of medical examiners State board of licensing Attorneys Drug Enforcement Agency Medical malpractice payers Most of these organizations must also report any adverse actions to the NPDB.

Malpractice 52

Malpractice Fraud Licensing Compliance 52

Physician Credentialing Company

JULY 23, 2024

In this blog, we will delve deep into the details of hospital credentialing steps, their importance, and the obstacles in undergoing this process. The Joint Commission, the Centers for Medicare & Medicaid Services (CMS), and other accrediting bodies have obliged healthcare organizations to comply with the regulatory policies.

Hospitals 52

Hospitals Licensing Malpractice Doctors 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

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. We’ll also review why both processes are vital for healthcare organizations.

Licensing 52

Licensing Governance Compliance Fraud 52

MedTrainer

DECEMBER 20, 2023

Medicaid Proof of Submission Required NJ FamilyCare, New Jersey’s Medicaid , requires proof of submission for enrollment if the provider does not include a Medicaid ID in the application. Background Checks. Payer Enrollment.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

MedTrainer

MAY 29, 2024

One of the newest changes that impacts medical credentialing services in Oklahoma is a major change to SoonerCare, the state’s Medicaid program. Ensuring the provider’s CAQH profile is up to date, and if the provider will also be enrolling in SoonerCare, Oklahoma’s Medicaid program, you’ll want to ensure the provider has a profile.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

Verisys

FEBRUARY 2, 2025

The Centers for Medicare and Medicaid Services (CMS) established credentialing by proxy as a way for telehealth practitioners to save time and money during the credentialing process. The most frequently missing data are work history and current work status, malpractice insurance, hospital privileges, and attestations.

Hospitals 52

Hospitals COVID-19 Licensing Medicare 52

MedTrainer

NOVEMBER 27, 2023

The Ohio Department of Medicaid is responsible for administering the state’s Medicaid, a comprehensive healthcare program that provides medical coverage to low-income individuals and families in Ohio. This department focuses on ensuring access to quality healthcare services while managing the state’s Medicaid budget and policies.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

APRIL 18, 2024

In this blog post, we’ll explore these and how behavioral health practices are adopting technology to prepare for the future. This may include proof of licensure, certification, accreditation, malpractice insurance, DEA registration (if applicable), and other supporting documentation.

Medicare 52

Medicare Medicare Licensing Compliance 52

Verisys

DECEMBER 1, 2023

It allows organizations to stay compliant with state and federal requirements and maintains their accreditation with Medicare, Medicaid, TRICARE, and other programs. NCQA certification has become essential to identifying industry standards and quality. Verisys has been NCQA and URAC accredited since 2008.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

MedTrainer

OCTOBER 29, 2023

Additional Medicaid Requirements Providers who participate in the Child Health Plan Plus (CHP+) and Health First Colorado (Colorado’s Medicaid program) are required to submit the enrollment fee ($688 in 2023) with their application. Background Checks. Payer Enrollment.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

MedTrainer

AUGUST 5, 2024

Proper privileging documentation is also critical to meet the standards of regulatory bodies such as the Centers for Medicare and Medicaid Services ( CMS ) and the National Committee for Quality Assurance ( NCQA ). Such lawsuits can threaten a hospital’s ability to participate in federally funded programs like Medicare and Medicaid.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

AIHC

AUGUST 30, 2023

We couldn’t talk about websites without mentioning “Blogs”. Blogs can be used for various purposes which can be a great way for sharing information. The key to blogs is you do have to keep them updated. Identity theft: Telemarketers steal personal information from individuals to submit fraudulent claims to Medicare and Medicaid.

Compliance 52

Compliance Fraud Medicare Medicare 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

Verisys

APRIL 27, 2023

A single search through FACIS screens over 5,500 primary sources, including the following: License status in each US jurisdiction where one is held Exclusion from Medicaid or Medicare participation Civil and criminal background checks Specialty board certification Drug Enforcement Agency verification Malpractice certification and claims history A (..)

Malpractice 52

Malpractice Licensing Fraud Medicaid 52

Verisys

DECEMBER 5, 2023

The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs. The policy issuer for malpractice insurance verifies insurance coverage.

Governance 52

Governance Licensing Malpractice Medicaid 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. The specialist contacts other parties and primary sources to verify the provider’s information – prior employers, references, and educational institutions.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

MedTrainer

JANUARY 13, 2025

This includes all credential types: license to practice, board certification, work history, malpractice history, state licensing sanctions, and both Medicare/Medicaid sanctions and exclusions. Changes to credentialing application. The application attestation timeframe has been shortened considerably.

Licensing 52

Licensing Malpractice Medicaid Medicaid 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

Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”). Hall Render blog posts and articles are intended for informational purposes only.

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Medicare Medicare Licensing Malpractice 40