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. However eMedNY, the New York Medicaid program , asks for a paper application that needs to be sent via postal mail. Background Checks.

Malpractice 52

Malpractice Medicaid Medicaid Licensing 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

MedTrainer

MAY 6, 2024

This blog will highlight how credentialers can navigate Aetna provider enrollment. As a healthcare organization, you understand the importance of working with insurance payers to ensure smooth and timely reimbursement. The challenge is meeting each payer’s unique provider credentialing and enrollment process requirements.

Licensing 52

Licensing Malpractice Health Insurance 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

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. We’ll also review why both processes are vital for healthcare organizations.

Licensing 52

Licensing Governance Compliance Fraud 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

AIHC

AUGUST 30, 2023

We couldn’t talk about websites without mentioning “Blogs”. Blogs can be used for various purposes which can be a great way for sharing information. The key to blogs is you do have to keep them updated. The good news, Medicare does have a “Hot Line” for providers to call in which I gave her.

Compliance 52

Compliance Fraud Medicare Medicare 52

MedTrainer

DECEMBER 20, 2023

Medicaid Proof of Submission Required NJ FamilyCare, New Jersey’s Medicaid , requires proof of submission for enrollment if the provider does not include a Medicaid ID in the application. Primary Source Verification. Background Checks. Payer Enrollment.

Licensing 52

Licensing Medicaid Medicaid Malpractice 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

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

NOVEMBER 27, 2023

The Ohio Department of Medicaid is responsible for administering the state’s Medicaid, a comprehensive healthcare program that provides medical coverage to low-income individuals and families in Ohio. This department focuses on ensuring access to quality healthcare services while managing the state’s Medicaid budget and policies.

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

MedTrainer

OCTOBER 29, 2023

Additional Medicaid Requirements Providers who participate in the Child Health Plan Plus (CHP+) and Health First Colorado (Colorado’s Medicaid program) are required to submit the enrollment fee ($688 in 2023) with their application. Primary Source Verification. Background Checks. Payer Enrollment.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Hall Render

SEPTEMBER 2, 2022

On July 26, 2022, the Centers for Medicaid and Medicare (“CMS”) published the 2023 Hospital Outpatient Prospective Payment System (OOPS) and Ambulatory Surgery Center Payment System Proposed Rule. The Consolidated Appropriations Act, 2021, signed into law on December 27, 2020, created a new Medicare provider type called an REH.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

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. Primary Source Verification. Background Checks. Payer Enrollment.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

AIHC

JANUARY 5, 2022

Think Again blog post related to the January 1, 2022, implementation of the Interim Final Rule (IFR) of the No Surprises Act. These don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. Identify eligible cases.

Medical Billing 52

Medical Billing Health Insurance Hospitals Medicare 52

Med Law Blog

MAY 1, 2023

Please note that the potential for ulterior financial motives does not automatically presume that the intent is somehow suspect, in the same way that potential medical malpractice concerns does not legitimately question the clinical motives of all other providers.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

Provider Trust

APRIL 14, 2023

In addition, organizations should monitor reports about medical incidents, disciplinary action, and malpractice claims involving their providers.

Licensing 52

Licensing Compliance Malpractice 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

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 27, 2023

A single search through FACIS screens over 5,500 primary sources, including the following: License status in each US jurisdiction where one is held Exclusion from Medicaid or Medicare participation Civil and criminal background checks Specialty board certification Drug Enforcement Agency verification Malpractice certification and claims history A (..)

Malpractice 52

Malpractice Licensing Fraud Medicaid 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

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%

Nursing Homes 40

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

Verisys

MARCH 30, 2023

Healthcare organizations must regularly check practitioners’ qualifications and license status to comply with regulations and to ensure payment from private and government agencies like Medicare and Medicaid. What are the requirements for medical credentialing?

Licensing 52

Licensing Malpractice Medicaid Medicaid 52