Verisys

MARCH 6, 2025

Mitigating Risks for Healthcare Organizations By verifying that all providers are properly credentialed, organizations minimize the potential for malpractice claims, legal disputes, and reputational damage. Healthcare administrators and compliance officers must be prepared to navigate these obstacles to maintain a seamless, efficient process.

Licensing 52

Licensing Compliance Nurses Malpractice 52

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 guidelines should be checked if you are billing this payer. Documentation is a key requirement in every billing task.

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 52

The Health Law Firm Blog

JUNE 14, 2024

Proper documentation of client treatment records is crucial for defending against malpractice lawsuits, licensing board complaints, ethics complaints and Medicare or [.]

Malpractice 52

Malpractice Licensing Medicare Medicare 52

Verisys

MARCH 6, 2025

Preventing documentation from falling through the cracks can help ensure patients receive the medical care they deserve. Consider a hospital hiring a new physician based on an old record that doesnt reflect a recent malpractice claimthis oversight can lead to severe legal and reputational consequences.

Compliance 52

Compliance Licensing Doctors Malpractice 52

Verisys

APRIL 3, 2025

Data inaccuracies: A misspelled name, incorrect license number, or missing documentation might seem minor, but they can lead to license and certification rejections, compliance violations, and delayed insurance reimbursementspotentially causing financial and operational headaches.

US Department of Health and Human Services 52

US Department of Health and Human Services Licensing Compliance Malpractice 52

Verisys

DECEMBER 29, 2024

This includes verifying education, residency, employment history, malpractice insurance, hospital privileges, and board certifications. It plays a key role in reducing malpractice risks, preventing fraud, and verifying that healthcare professionals have the necessary training and clinical experience to perform their duties.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

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

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 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. Ensure the provider’s CAQH profile is up to date and set up a PECOS portal if the provider will be enrolling with Medicare. Primary Source Verification. Privileging.

Medicaid 52

Medicaid Medicaid Medicare Medicare 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

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 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. Make it easy for providers to submit documents. Primary Source Verification. Background Checks.

Malpractice 52

Malpractice Medicaid Medicaid 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

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

APRIL 26, 2024

Primary source verification involves contacting original sources — such as educational institutions, licensing boards, and certification bodies — to confirm the authenticity and accuracy of the documents and qualifications provided by the provider. Make it easy for dentists to submit documents. Work History and Reference Checks.

Medicare 52

Medicare Medicare Licensing Malpractice 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

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

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

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

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

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

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.

Malpractice 52

Malpractice Medical Billing Outsourcing Governance Patient Satisfaction 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

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

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

Medisys Compliance

OCTOBER 30, 2023

Here are the general steps involved: Gather Required Documents: Collect all the necessary documents, such as your professional license, certifications, malpractice insurance, and practice information. Submit Applications: Send the completed applications along with the required documents to the insurance companies.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Malpractice Licensing 59

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

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

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. The following items are required for enrollment in Medicare: A primary place of service must be in operation.

Medicare 52

Medicare Medicare Medicaid 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

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

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. The software helps to keep documents and policies organized, ensures training content is up-to-date, and makes reporting easy.

Compliance 52

Compliance Licensing Medicaid 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

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