Physician Credentialing Company

DECEMBER 20, 2024

It acts as a shield against malpractice claims under the False Claim Act. Documentation should also be maintained on how providers supervised non-credentialed providers and the type of rendered services. Medicare and Medicaid allow non-credentialed providers to get reimbursement but under strict rules.

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 52

Physician Credentialing Company

DECEMBER 27, 2024

It is a standardized code to describe the services provided to a patient and thus, avoids any reimbursement and documentation issues. In order to document the level of service rendered, healthcare providers must take a medical history from the patient, execute a problem focused exam, and formulate a treatment plan.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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 30, 2024

Healthcare credentialers must collect an average of 30 documents per provider to initiate and complete the credentialing process – also known as primary source verification (PSV). They also conduct background checks, which require calling law enforcement and other regulatory agencies for criminal records and malpractice history.

Licensing 52

Licensing Malpractice Medicare Medicare 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

MedTrainer

MAY 15, 2024

Since surveyors are likely to perform an unannounced audit to review the provider credentialing files for a random provider document or recredentialing date, having everything stored in MedTrainer’s credentialing platform is really helpful. An this is information that is completed annually. Payers in New York have specific requirements.

Malpractice 52

Malpractice Medicaid Medicaid Licensing 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

MAY 7, 2024

We’ll walk you through the steps in enrolling your providers with UnitedHealthcare, the information and documents you need, and the best practices to follow. This blog will highlight how credentialers can navigate UnitedHealthcare provider enrollment. Why Is Payer Enrollment Important for Healthcare Providers?

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 20, 2023

What’s Unique About Medical Credentialing in New Jersey Horizon NJ Health Requirements Horizon NJ Health is New Jersey’s largest insurance provider and requires the most documentation for provider enrollment. Make sure you start collecting documents as soon the provider is hired and encourage the provider to set up any online portals.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

Medisys Compliance

MARCH 21, 2023

By verifying a doctor’s credentials, insurance companies can mitigate the risk of malpractice claims and ensure patient safety. In addition to the application form, the doctor may also be required to submit additional documentation to support their application, such as transcripts, diplomas, certificates, and other credentials.

Doctors 52

Doctors Malpractice Licensing Medical Billing Outsourcing 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

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

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

Verisys

FEBRUARY 2, 2025

They then verify that the documentation is accurate, genuine, current, and in good standing, ensuring compliance with all credentialing requirements. Each healthcare facility may use its own methods to collect and verify information, but they must adhere to the same documentation requirements.

Hospitals 52

Hospitals COVID-19 Licensing 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. Make it easy for providers to submit documents. Payers in Colorado have specific requirements.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

MedTrainer

AUGUST 5, 2024

The extensive administrative workload required to gather, verify, and review all necessary documentation can strain staff and delay bringing new providers on board, directly impacting patient care and revenue. 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

AUGUST 17, 2023

Mitigating liability and legal risks Malpractice claims and legal disputes can financially and emotionally drain healthcare providers and organizations. Your organization is also responsible for reviewing documentation from the CVO and making a credentialing decision. Here at Verisys, we make credentialing easy.

Malpractice 52

Malpractice Licensing Compliance Medicaid 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

With a whole new group of provider enrollments starting from scratch, credentialers will likely be juggling towers of documents and data for the foreseeable future. Credentialing Documentation: Behavioral health providers must gather and submit extensive documentation for the Medicare enrollment process.

Medicare 52

Medicare Medicare Licensing Compliance 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

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

NOVEMBER 21, 2024

We will also discuss the documents needed and various credentialing challenges. Gather Required Documents The credentialing process requires extensive documents that are used to assess the educational status and skills of the provider. Provide additional information and documents if needed. Otherwise, continue reading: 1.

Licensing 52

Licensing Malpractice Medicaid Medicaid 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

AIHC

SEPTEMBER 5, 2023

Keep in mind coding and documentation is extremely important for psychiatric services – consider registering for the Psychiatric Compliance – coding & documentation short course offered by the American Institute of Healthcare Compliance. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

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 will send you a preliminary report, which you will review and return with any additional documentation needed within two weeks.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Physician Credentialing Company

OCTOBER 25, 2024

These codes are crucial in ensuring that medical services are accompanied by the right documentation and billing practices making the healthcare system effective. Differences between 90834 and similar codes, documentation requirements, and CPT code 90834 reimbursement tips will also be discussed.

Licensing 52

Licensing Medical Billing Telemedicine Medicare 52

Medisys Compliance

MARCH 27, 2023

These terminologies are briefly discussed below for better understanding: Provider enrollment: This refers to the process of enrolling a healthcare provider with an insurance plan or government program, such as Medicare or Medicaid. By meeting these requirements, providers can expand their patient base and increase revenue.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Malpractice Governance Patient Satisfaction 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

Verisys

DECEMBER 23, 2021

Medicare, Medicaid, and TRICARE: How Enrollment Standards Differ. Provider enrollment in Medicare, Medicaid, TRICARE, and other government health programs all involve a lengthy process, with some variation. Citizenship documents are required for providers born as non-U.S. High number of malpractice cases.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

OCTOBER 26, 2023

The most important thing to know before you get started is that Washington requires all documents, applications, and information be submitted through their online portals. Providers upload information and documentation to the secure database and attest to it multiple times a year. Work History and Reference Checks. Background Checks.

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52

MedTrainer

MAY 6, 2024

We’ll walk you through the steps to enroll providers with Aetna (a CVS Health company), the information and documents you’ll need, and best practices to follow. This blog will highlight how credentialers can navigate Aetna provider enrollment. Why Is Payer Enrollment Important For Healthcare Organizations?

Licensing 52

Licensing Malpractice Health Insurance Medicaid 52

Physician Credentialing Company

JULY 23, 2024

The Joint Commission, the Centers for Medicare & Medicaid Services (CMS), and other accrediting bodies have obliged healthcare organizations to comply with the regulatory policies. These documentations are asked to be checked and verified for originality. This step ensures that fraudulent people are not practicing medicine.

Hospitals 52

Hospitals Licensing Malpractice Doctors 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

Verisys

MARCH 1, 2022

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

Medisys Compliance

MARCH 23, 2023

Coding: When a mental health provider submits patient data, we review the documentation to determine the appropriate CPT (Current Procedural Terminology) codes to assign to the services provided. In our credentialing services we assist you in entire credentialing process for all insurance companies including Medicare and Medicaid.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Malpractice Health Insurance 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

AIHC

APRIL 25, 2022

o If so, is the organization's current mobile device configuration document, including connections to other systems/applications, inside and outside of the firewall. As AIHC advises, another resource is legal advice through your malpractice insurance company. Information Storage on Mobile Devices ?

HIPAA 52

HIPAA COVID-19 Compliance Compliance Officers 52