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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.
Department of Health and Human Services (HHS) and contains medical malpractice payments and adverse action reports on healthcare professionals. ProviderTrust previously collaborated with an NPDB expert, Alex Fisher (Attorney, Frost, Brown, Todd), in a webinar. For more information, view the webinar on demand.
They also conduct background checks, which require calling law enforcement and other regulatory agencies for criminal records and malpractice history. WEBINAR: Credentialing Is Evolving. Traditionally, credentialers call the appropriate entities to verify transcripts, licenses, etc.
Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. Watch this on-demand webinar to get tips to speed up your enrollment process. The employer may also review any pending and past medical malpractice cases or disciplinary actions.
Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority. Watch this on-demand webinar for insights to improve your internal credentialing. Upon completion and approval, the provider can begin billing for medical services.
WEBINAR: Hear how Kasey Krabler of Rocky Mountain Surgical Center completes privileging in 30 days. 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 ).
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.
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. High number of malpractice cases. View our recent webinar given by 30-year industry expert Tracey Tokheim.
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