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.

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Medicaid Medicaid Medicare Medicare 52

MedTrainer

FEBRUARY 5, 2024

In this blog, we’ll discuss the two processes and key differences between provider enrollment and credentialing. Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. The information confirms a provider is currently licensed to practice medicine.

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Licensing Governance Compliance Fraud 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

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

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.

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Medicare Medicare Licensing Malpractice 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?

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Fraud Compliance Medicaid Medicaid 98

MedTrainer

MARCH 14, 2024

The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority.

Malpractice 52

Malpractice Licensing Hospitals Compliance 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.

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Licensing Medicaid Medicaid Malpractice 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.

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Licensing Malpractice Medicaid Medicaid 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

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.

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Licensing Malpractice Medicaid 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

Verisys

DECEMBER 5, 2023

State licensing boards verify practitioner license type and status. 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. And the list goes on.…

Governance 52

Governance Licensing Malpractice Medicaid 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.

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Medicaid Medicaid Medicare Medicare 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

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

APRIL 7, 2023

Most hospitals use the Office of Inspector General’s List of Excluded Individuals and Entities ( OIG-LEIE ) for primary source verification, which consists of current providers and entities excluded from participating in all federal healthcare programs like Medicaid or Medicare.

Licensing 52

Licensing Malpractice Hospitals Medicaid 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

Verisys

MARCH 30, 2023

How to Better Protect your Organization Through Medical Credentialing Medical credentialing – the tedious but necessary process of verifying a provider’s credentials, including license(s) and exclusion status, education, and training. Medical credentialing , unfortunately, isn’t one-and-done at the time of hire.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Hall Render

APRIL 14, 2023

NATIONAL 94% of Organizations Experienced a Cyberattack in 2022 AHA blog: Strengthening crisis management in rural health care Biden signs bill ending Covid-19 national emergency Cancer drug shortages are creating dire circumstances for some patients CMS Releases FY24 IPPS Proposed Rule, Seeks to Boost Rates by 2.8%

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Nursing Homes US Department of Health and Human Services Nurses COVID-19 40