Verisys

APRIL 3, 2025

Faster Verification Automated systems instantly verify licenses , certifications, and malpractice history by pulling data from authoritative sources in secondssomething that would take human credentialing teams weeks to complete. Lets dive deeper and break down its key benefits.

Licensing 52

Licensing Malpractice Compliance Nurses 52

MedTrainer

MARCH 30, 2024

Enrollment Application Checklist Gather Training and Education Practitioner degree (MD, DO, DPM), post-graduate education or training Medical or professional education/training details Designated specialty residency completion Gather Licensing and Certification Current license/certification in the state(s) where provider will be practicing No temporary (..)

Malpractice 98

Malpractice Licensing Medicaid Medicaid 98

HIT Consultant

FEBRUARY 5, 2024

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 96

Malpractice Licensing Due Diligence Hospitals 96

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

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. Inadequate Data Validation Without proper validation processes, organizations risk relying on outdated or incorrect information.

Compliance 52

Compliance Licensing Doctors Malpractice 52

Physician Credentialing Company

DECEMBER 27, 2024

How Much Does Medicare Pay Credited to CPT code for 99213? Over the years, one of the questions we get asked most often is, What does Medicare pay for CPT code for 99213? Medicare reimbursement rates vary slightly by geographic location and annual fee schedule updates made by the Centers for Medicare & Medicaid Services (CMS).

Medicare 40

Medicare Medicare Medicaid Medicaid 40

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.

Licensing 52

Licensing Compliance Nurses Malpractice 52

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

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 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

APRIL 3, 2025

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.

US Department of Health and Human Services 52

US Department of Health and Human Services Licensing Compliance Malpractice 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

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

Verisys

FEBRUARY 3, 2025

This includes verifying qualifications, submitting proof of malpractice insurance , and ensuring compliance with all healthcare regulatory compliance standards. court documents, dismissals) for all malpractice/disciplinary actions OR completion of appropriate explanation form (if applicable).

Malpractice 52

Malpractice Regulatory Compliance Licensing Compliance 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

Medisys Compliance

MARCH 21, 2023

By verifying a doctor’s credentials, insurance companies can mitigate the risk of malpractice claims and ensure patient safety. Verification of Malpractice Insurance The fourth step in the credentialing process is to verify that the doctor has malpractice insurance.

Doctors 52

Doctors Malpractice Licensing Medical Billing Outsourcing 52

HIT Consultant

AUGUST 5, 2022

CMS Proposed Changes to the Physician Fee Schedule 2023 : On July 7, 2022, the CMS announced that it is soliciting public comment on proposed policy changes for Medicare payments under the Physician Fee Schedule (“PFS”) effective on or after January 1, 2023. The proposed changes would reduce the conversion factor by 4.4% from $34.61

Telemedicine 98

Telemedicine Medicaid Medicaid Malpractice 98

MedTrainer

MAY 7, 2024

Here is a list of the information you’ll need to gather for UnitedHealthcare credentialing: Training and Education Practitioner degree (M.D.,

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52

Verisys

JANUARY 19, 2022

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. The cost of poor medical credentialing is estimated to exceed $36,000 per bed.

US Department of Health and Human Services 52

US Department of Health and Human Services Hospitals Malpractice Compliance Officers 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

Verisys

FEBRUARY 4, 2022

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. The NPDB requires reporting of the following actions: Medical malpractice payments. Mistake No. Mistake No.

Malpractice 52

Malpractice Licensing Due Diligence Hospitals 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

Total Medical ComplianceHIPAA

JANUARY 11, 2024

These screenings search through various databases containing records of individuals or organizations barred from participating in Medicaid, Medicare, or other federal/state healthcare programs due to fraud, abuse, or other offenses. Why is Sanction Screening Vital Under HIPAA?

HIPAA 52

HIPAA Malpractice Regulatory Compliance Compliance 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

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. Violations to these laws can result in fines, prison time, and/or exclusion from the Medicare and/or Medicaid programs.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

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

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

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 distant site must be certified as a Medicare or telehealth facility. CMS has also waived certain requirements during the COVID-19 crisis.

Hospitals 52

Hospitals COVID-19 Licensing Medicare 52

Hall Render

JANUARY 7, 2025

Ryan honed his litigation skills defending and trying criminal cases, civil rights violations, medical malpractice cases and complex business lawsuits from inception through trial. Ryan received his J.D. from Washington University in St.

Malpractice 40

Malpractice Medicare Medicare Governance 40

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

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

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

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