Healthcare Blog

OCTOBER 31, 2024

It can also result in costly fines, a tarnished reputation, and exclusion from essential federal programs like Medicare. Furthermore, happy patients are less likely to bring malpractice and other personal injury claims against your healthcare organization.

Regulatory Compliance 91

Regulatory Compliance Nurses Compliance Malpractice 91

MedTrainer

JULY 28, 2023

OIG Inspections in Healthcare The OIG focuses its resources on oversight of Medicare and Medicaid — programs that represent a large portion of the federal budget. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers. What Is the Scope of an OIG Inspection?

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

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. Providers are billed after getting registered with Medicare and receiving a PTAN number, but it is still better than not doing anything. How Long Does It Take To Get Credentialed With Medicare?

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

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

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

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

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?

Licensing 52

Licensing Governance Compliance Fraud 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 15, 2024

The state requires a process similar to Medicare , which includes obtaining DMEPOS accreditation from a CMS-approved organization, enrolling in Medicare, and posting a surety bond to the enrollment contractor. Ensure the provider’s CAQH profile is up to date and set up a PECOS portal if the provider will be enrolling with Medicare.

Medicaid 52

Medicaid Medicaid Medicare Medicare 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 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. Ensure the provider’s CAQH profile is up to date and if the provider will be enrolling with Medicare, set up a PECOS portal as well.

Malpractice 52

Malpractice Medicaid Medicaid Licensing 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

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. The good news, Medicare does have a “Hot Line” for providers to call in which I gave her.

Compliance 52

Compliance Fraud Medicare Medicare 52

MedTrainer

APRIL 26, 2024

Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. To assess the dentist’s experience and reputation within the healthcare community, the work history must be verified without any gaps longer than 30 days. Background Checks.

Medicare 52

Medicare Medicare Licensing Malpractice 52

Hall Render

SEPTEMBER 2, 2022

On July 26, 2022, the Centers for Medicaid and Medicare (“CMS”) published the 2023 Hospital Outpatient Prospective Payment System (OOPS) and Ambulatory Surgery Center Payment System Proposed Rule. The Consolidated Appropriations Act, 2021, signed into law on December 27, 2020, created a new Medicare provider type called an REH.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

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

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

Physician Credentialing Company

DECEMBER 20, 2024

It acts as a shield against malpractice claims under the False Claim Act. Medicare guidelines should be checked if you are billing this payer. Medicare and Medicaid allow non-credentialed providers to get reimbursement but under strict rules. In order to stay aligned with medical practice, they need to see patients and work.

Medical Billing 52

Medical Billing Compliance Malpractice 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

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

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

Physician Credentialing Company

OCTOBER 25, 2024

Medicare and Medicaid may have different payment systems from those of the private health insurance plans. The lack of documentation may result in an audit, leading to claim denial and fines for noncompliance with Medicare and Medicaid regulations. Also read our blog to know about the 90833 CPT. 2022: $112.29 2021: $103.28

Licensing 52

Licensing Medical Billing Telemedicine Medicare 52

AIHC

JANUARY 5, 2022

Think Again blog post related to the January 1, 2022, implementation of the Interim Final Rule (IFR) of the No Surprises Act. These don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. Identify eligible cases.

Medical Billing 52

Medical Billing Health Insurance Hospitals Medicare 52

MedTrainer

MAY 29, 2024

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. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags.

Medicaid 52

Medicaid Medicaid Malpractice Licensing 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

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

OCTOBER 29, 2023

Ensure the provider’s CAQH profile is up-to-date and if the provider will be enrolling with Medicare and Health First Colorado , set up those portals as well. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. Background Checks.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

MedTrainer

OCTOBER 29, 2023

Ensure the provider’s CAQH profile is up to date and if the provider will be enrolling with Medicare and the state’s Medicaid program, called Medi-Cal , set up those portals as well. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

MedTrainer

DECEMBER 20, 2023

Ensure the provider’s CAQH profile is up-to-date and if the provider will be enrolling with Medicare and Availity payers, set up those portals as well. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. Primary Source Verification.

Licensing 52

Licensing Medicaid Medicaid Malpractice 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

Provider Trust

APRIL 14, 2023

In addition, organizations should monitor reports about medical incidents, disciplinary action, and malpractice claims involving their providers.

Licensing 52

Licensing Compliance Malpractice Medicaid 52

MedTrainer

NOVEMBER 27, 2023

To be eligible, hospitals must submit a complete application, be certified or accredited by the Centers for Medicare and Medicaid Services (CMS), demonstrate compliance with ODH standards, and specify bed numbers. Hospital Licensure Effective September 30, 2024 , Ohio hospitals must obtain licensure from the Ohio Department of Health (ODH).

Compliance 52

Compliance Licensing Medicaid Medicaid 52

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. What are the requirements for medical credentialing? A practitioner must submit several documents to start the credentialing process.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Verisys

APRIL 7, 2023

Most hospitals use the Office of Inspector General’s List of Excluded Individuals and Entities ( OIG-LEIE ) for primary source verification, which consists of current providers and entities excluded from participating in all federal healthcare programs like Medicaid or Medicare.

Licensing 52

Licensing Malpractice Hospitals Medicaid 52