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

The Health Law Firm Blog

APRIL 19, 2024

Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.] Indest III, J.D.,

Malpractice 52

Malpractice Overpayment Overpayments Licensing 52

The Health Law Firm Blog

JANUARY 24, 2023

Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.] Indest III, J.D.,

Malpractice 52

Malpractice Overpayment Overpayments Licensing 52

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

Medicare 52

Medicare Medicare Licensing 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

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

Verisys

FEBRUARY 3, 2025

As a healthcare provider, whether a physician, nurse, or specialist, obtaining medical licenses and completing the credentialing process are essential. This includes verifying qualifications, submitting proof of malpractice insurance , and ensuring compliance with all healthcare regulatory compliance standards.

Malpractice 52

Malpractice Regulatory Compliance Licensing Compliance 52

Verisys

DECEMBER 29, 2024

This includes verifying education, residency, employment history, malpractice insurance, hospital privileges, and board certifications. Credentialing services perform this verification by contacting primary sources, such as medical schools and licensing boards, to confirm the physician’s education and qualifications.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 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

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”).

Medicare 40

Medicare Medicare Licensing Malpractice 40

MedTrainer

MAY 7, 2024

Here are the key steps: Gather Training and Education Gather Licensing and Certification Gather Work History Details Gather Payer-Specific Requirements Following Application Submission Get the tools you need to eliminate delays in your provider enrollment process.

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. Liability issues can even result in the termination of their license. How Long Does It Take To Get Credentialed With Medicare? It takes 60-90 days to get credentialed with Medicare.

Malpractice 52

Malpractice Medicare Medicare Medicaid 52

Verisys

NOVEMBER 30, 2023

Credentialing lapses can expose a healthcare organization to malpractice suits and accreditation problems. All certifications and licenses must be verified for every provider who administers services to patients. This creates the potential for negative patient outcomes, which can lead to expensive malpractice lawsuits.

Malpractice 52

Malpractice Licensing Due Diligence Hospitals 52

Verisys

FEBRUARY 4, 2022

Credentialing lapses can expose a healthcare organization to malpractice suits and accreditation problems. All certifications and licenses must be verified for every provider who administers services to patients. This creates the potential for negative patient outcomes, which can lead to expensive malpractice lawsuits.

Malpractice 52

Malpractice Licensing Due Diligence Hospitals 52

Medisys Compliance

MARCH 21, 2023

By credentialing doctors, insurance companies can ensure that their customers receive high-quality care and that the doctors they work with are qualified and licensed to provide the care they need. By verifying a doctor’s credentials, insurance companies can mitigate the risk of malpractice claims and ensure patient safety.

Doctors 52

Doctors Malpractice Licensing Medical Billing Outsourcing 52

Verisys

JULY 20, 2023

An organization must verify all certifications and licenses for every provider who administers patient services. 4: Not updating and verifying information Healthcare practitioners need to renew their licenses and credentials on a regular basis, according to federal and state laws. Mistake No. Mistake No. Mistake No. Mistake No.

Due Diligence 52

Due Diligence Malpractice Licensing Hospitals 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 practitioner must provide a license to practice. The distant site must be certified as a Medicare or telehealth facility.

Hospitals 52

Hospitals COVID-19 Licensing Medicare 52

Verisys

JANUARY 19, 2022

Ensures proper credentialing and privileging of the licensed medical staff. It’s also a requirement of federal payers like Medicare, Medicaid, and private insurance companies. In addition, there can be other indirect costs, such as rising malpractice insurance costs and associated fiscal penalties. Human Resources.

US Department of Health and Human Services 52

US Department of Health and Human Services Hospitals Malpractice Compliance Officers 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. This doesnt call for monthly monitoring of all credential information only monthly monitoring of the license expiration date.

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

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. If the dentist is being credentialed in a state with its own portal, set that up as well.

Medicare 52

Medicare Medicare Licensing Malpractice 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

Physician Credentialing Company

OCTOBER 25, 2024

For example, a psychotherapist who has a professional practicing license might embrace the cognitive-behavioral approach to urge the patient to overcome negative thinking methods. Only licensed mental health professionals are permitted to send the bill for the services offered defined by code 90834. Who can Bill CPT Code 90834?

Licensing 52

Licensing Medical Billing Telemedicine Medicare 52

MedTrainer

MAY 6, 2024

Here are the key steps: Gather Training and Education Gather Licensing and Certification Gather Work History Details Gather Payer-Specific Requirements Following Application Submission Get the tools you need to eliminate delays in your provider enrollment process.

Licensing 52

Licensing Malpractice Health Insurance Medicaid 52

Provider Trust

APRIL 14, 2023

When a healthcare provider or organization bills a payer for services rendered, payers need up-to-date credentialing data to ensure these providers are properly licensed to give expert clinical services. Additionally, disparate primary source data can be outdated and/or incomplete and often disconnected across state lines.

Licensing 52

Licensing Compliance Malpractice Medicaid 52

MedTrainer

MARCH 5, 2025

Imagine discovering your surgeon’s license expired six months ago, or learning that your hospital is losing millions in revenue because of inaccurate details that cause denied claims. Missing a single expired license or skipping one background check can lead to denied claims, legal liability, and damaged reputations.

Licensing 52

Licensing Compliance Malpractice Medicare 52

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses.

Licensing 52

Licensing Governance Compliance Fraud 52

MedTrainer

OCTOBER 29, 2023

Physical License Only California currently provides physical licenses for practitioners. This wallet-size license requires holders to scan, photocopy, or take a picture for recredenialing or verification. It can take as long as four to five months to credential a new provider simply because of this backlog. Background Checks.

Licensing 52

Licensing Malpractice Medicaid Medicaid 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

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

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This compact does not apply to nurse practitioners (NPs) because they are licensed under state boards of nursing and not medicine.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

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

NOVEMBER 27, 2023

The State Medical Board of Ohio provides licensing and regulatory guidelines for medical providers in Ohio State. The Counselor, Social Worker, and Marriage and Family Therapist Board oversees regulatory adherence and licensing for mental/behavioral health providers and social workers.

Compliance 52

Compliance Licensing 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

MedTrainer

DECEMBER 20, 2023

Both licensing and credentialing processes are pivotal in upholding the integrity and safety of healthcare delivery in the state of New Jersey. The New Jersey State Board of Medical Examiners oversees medical credentialing and licensing within the state. Primary Source Verification. Background Checks. Payer Enrollment.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

Verisys

APRIL 27, 2023

If an application is missing key pieces, such as a scan through a primary source or a copy of their license, table the application. Only review files with complete applications. These files should not be sent to committee members or discussed at the credentialing committee meeting until the file is complete.

Malpractice 52

Malpractice Licensing Fraud Medicaid 52

MedTrainer

OCTOBER 29, 2023

The Colorado Medical Board oversees medical credentialing and licensing within the state. Controlled Substance Licensure Colorado has a one license requirement for controlled substance licensure. Revalidation every five years is required for providers to remain enrolled. Primary Source Verification. Background Checks. Payer Enrollment.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52