MedTrainer

FEBRUARY 5, 2024

This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses. Provider enrollment confirms the healthcare provider meets and maintains certain compliance standards for the insurance or payer network. What is Provider Credentialing?

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Licensing Governance Compliance Fraud 52

MedTrainer

JULY 10, 2023

That’s why medical credentialing is such a crucial part of compliance for healthcare organizations and the providers working within them. It’s an absolutely essential part of compliance management. There are numerous important objectives behind the process of medical credentialing — many of them rooted in compliance.

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Malpractice Compliance Licensing Hospitals 52

McBrayer Law Blog

SEPTEMBER 19, 2022

Often, these procedures require the supervision of a licensed physician or nurse practitioner, creating a unique regulatory issue.

Malpractice 52

Malpractice Nurses Licensing Compliance 52

MedTrainer

APRIL 18, 2024

This may include proof of licensure, certification, accreditation, malpractice insurance, DEA registration (if applicable), and other supporting documentation. Navigating Appeals and Disputes: In some cases, behavioral health providers may encounter claim denials, audits, or disputes with Medicare regarding reimbursement or compliance issues.

Medicare 52

Medicare Medicare Licensing Compliance 52

MedTrainer

JULY 28, 2023

That mean, maintaining compliance standards, efficient reporting, and conducting thorough internal audits are vital. Download “Compliance Reports You Can’t Live Without” for OIG reporting templates and tips. This is done to ensure compliance with regulations, identify areas for improvement, and assess program effectiveness.

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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

JULY 10, 2023

That’s why medical credentialing is such a crucial part of compliance for healthcare organizations and the providers working within them. It’s an absolutely essential part of compliance management. There are numerous important objectives behind the process of medical credentialing — many of them rooted in compliance.

Malpractice 40

Malpractice Compliance Licensing Hospitals 40

MedTrainer

JULY 10, 2023

Even after someone goes through all the schooling, passes their medical boards and obtains a license to practice, physician credentialing still stands between a provider and patients — no matter where they are in their career. Malpractice history. Legal and regulatory compliance. Board certification. Work history. References.

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Malpractice Licensing Compliance Regulatory Compliance 40

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. Regardless of your approach, the credentialing process can be quite complex.

Licensing 52

Licensing Compliance Malpractice Medicaid 52

MedTrainer

APRIL 18, 2024

Credentialing Delays: The credentialing process can be lengthy, often involving gathering and verifying extensive documentation, including education, training, licensure, certifications, malpractice history, and references. Delays in this process can delay providers’ ability to practice in the ASC.

Licensing 52

Licensing Malpractice Compliance 52

MedTrainer

SEPTEMBER 20, 2023

Legal costs, settlements, and increased malpractice insurance premiums can put financial burdens on ASCs found guilty of negligent credentialing. This process should include comprehensive checks of education, training, licensure, malpractice history, and any disciplinary actions. Financial Consequences. Long-Term Consequences.

Malpractice 52

Malpractice Licensing Due Diligence Compliance 52

Verisys

JANUARY 19, 2022

According to recent surveys of major metropolitan hospitals , departments that typically share the responsibility for credentialing include: The Compliance Office. Checks credentialing for Health Insurance Portability and Accountability Act (HIPAA) compliance. Ensures proper credentialing and privileging of the licensed medical staff.

US Department of Health and Human Services 52

US Department of Health and Human Services Hospitals Malpractice Compliance Officers 52

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. This compact does not apply to nurse practitioners (NPs) because they are licensed under state boards of nursing and not medicine.

Telemedicine 59

Telemedicine COVID-19 Compliance Informed Consent 59

MedTrainer

AUGUST 9, 2023

Licenses and Certifications. Copies of all current and valid medical licenses, board certifications, and registrations must be submitted. Malpractice Insurance. Providers must show proof of malpractice insurance coverage or liability insurance to begin practicing. Work History. References. DEA Registration.

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Malpractice Licensing Compliance 52

Hall Render

DECEMBER 12, 2023

CMS stated that this could include any misdemeanor that places the Medicare program or its beneficiaries at immediate risk, such as a malpractice suit that results in a conviction of criminal neglect or misconduct. The stay of enrollment would last no longer than 60 days, and the provider will be given 15 days to submit a rebuttal.

Medicare 40

Medicare Medicare Licensing Malpractice 40

Medisys Compliance

MARCH 27, 2023

Provider screening: This is the process of screening healthcare providers to ensure they meet certain standards and criteria, such as background checks and license verifications. Insurance verification: The insurance company verifies that the provider has adequate malpractice insurance coverage.

Malpractice 52

Malpractice Medical Billing Outsourcing Governance Patient Satisfaction 52

Medisys Compliance

OCTOBER 30, 2023

Compliance: Proper credentialing and billing are essential for remaining compliant with state and federal regulations , avoiding legal issues, and protecting the practitioner’s reputation. Financial Stability: Accurate and timely billing is crucial to a solo practitioner’s financial stability.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Malpractice Licensing 59

Verisys

DECEMBER 5, 2023

State licensing boards verify practitioner license type and status. The policy issuer for malpractice insurance verifies insurance coverage. Because they have first-hand knowledge, these primary sources can confirm if the information claimed is accurate. Here are some examples: Medical schools verify completion of education.

Governance 52

Governance Licensing Malpractice Medicaid 52

HIT Consultant

SEPTEMBER 19, 2021

According to CRICO’s national CBS Database, 66% of malpractice cases in telemedicine from 2014 to 2018 were connected to misdiagnosis. Particularly the certification and license are one of the main challenges for nurses in telemedicine. Software legal compliance. Pandemic allowed those who were hesitant to try out telemedicine.

Telemedicine 98

Telemedicine Licensing Nurses HIPAA 98

Verisys

DECEMBER 1, 2023

As a CVO that has achieved this certification, Verisys can give partner organizations peace of mind that it is meeting the rigorous compliance standards set forth by NCQA. Verisys is one of only a handful of organizations that are NCQA certified in 11 of 11 credentials verification services.

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Medicaid Medicaid Medicare Medicare 52

AIHC

APRIL 25, 2022

Written by: Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, COCAS, CORCM, OHCC, ICDCT-CM/PCS This article addresses how to track telehealth policies while addressing HIPAA compliance and mobile device management as the United States enters into a post-pandemic era. What Additional Information Should I Know for Compliance?

HIPAA 52

HIPAA Compliance COVID-19 Compliance Officers 52

MedTrainer

FEBRUARY 13, 2022

By ensuring that healthcare providers have the proper license and documentation to provide treatment, they are safeguarding the health and wellbeing of their patients as well as protecting the facility from potential liabilities. Licensing Requirements: Ensuring that the healthcare professional has the proper licensing to practice medicine.

Licensing 40

Licensing Malpractice Governance Compliance 40

HIT Consultant

MARCH 6, 2023

Drug diversion can also pose risks to staff safety and regulatory compliance, as can be seen across all types of healthcare facilities and, across all clinical disciplines. Healthcare organizations face financial penalties, potentially in the millions, for lack of compliance with DEA regulations leading to diversion within their hospitals.

Regulatory Compliance 52

Regulatory Compliance Hospitals Malpractice Compliance 52

Verisys

MARCH 1, 2022

State licensing boards verify practitioner license type and status. The policy issuer for malpractice insurance verifies insurance coverage. Because they have first-hand knowledge, these primary sources can confirm if the information claimed is accurate. Here are some examples: Medical schools verify completion of education.

Governance 52

Governance Licensing Malpractice Medicaid 52

Florida Health Care Law Firm

APRIL 20, 2022

They require medical professionals of all kinds to attain a certain level of education in order to gain license to practice in the state. If you wish to file a complaint of malpractice with the Florida Medical Board, the process is especially tricky. Florida Medical Board Complaints.

Doctors 52

Doctors Malpractice Licensing Medicaid 52

MedTrainer

AUGUST 2, 2023

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. Primary Source Verification. Background Checks.

Due Diligence 52

Due Diligence Malpractice Licensing Compliance 52

MedTrainer

AUGUST 2, 2023

Good credentialing management opens the door to a wide range of benefits at both the facility and organization levels: Compliance With Regulatory Standards. Credentialing management helps organizations maintain compliance with regulatory standards set by accrediting bodies, government agencies, and industry regulators.

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Malpractice Compliance Licensing Due Diligence 97

HIT Consultant

FEBRUARY 5, 2024

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.

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Malpractice Licensing Due Diligence Hospitals 87

Matt Kinley

APRIL 11, 2018

A NEW MALPRACTICE ISSUE FOR HOSPITALS? Columbia University researchers found being in a bed previously used by a patient with an infection ups your own risk of infection by 583% (SEE ABSTRACT, HERE: [link] according to the current issue of Infection Control and Hospital Epidemiology.

Hospitals 40

Hospitals Malpractice Licensing Compliance 40

Verisys

DECEMBER 23, 2021

High number of malpractice cases. If a provider’s record shows a high number of cases, discipline by a licensing entity, or frequent moves, it may indicate a problem. Continuous monitoring and automated notifications for a provider’s license status through Verified License Search & Status (VLSS®). Vague references.

Medicare 52

Medicare Medicare Medicaid 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 10, 2022

Did you know that for every 1,000 licensed healthcare practitioners there will typically be 20 with inactive licenses, 10 with a suspended license, and another six practitioners with either a restricted or revoked license, or on probation? By carefully screening the practitioner and continually monitoring his license.

Licensing 52

Licensing US Department of Health and Human Services Malpractice Compliance 52

Bill of Health

APRIL 4, 2024

Although the cross-sectoral AI legislation that is now introduced by the European Commission’s Digital Strategy aims to be integrated with existing sectoral legislation such as the MDR, the IVDR and the Machinery Directive, it is uncertain how overlapping regulatory compliance requirements for AI-driven medical devices will be managed in practice.

FDA 282

FDA Regulatory Compliance Malpractice Health Insurance 282

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

MedTrainer

JUNE 29, 2023

Healthcare credentialing involves verifying various aspects of a healthcare professional’s background, including their education, training, certifications, licenses, work history, malpractice history, and any other relevant credentials. This can include résumés, licenses, diplomas, and insurance (payer) enrollments.

Licensing 52

Licensing Compliance Malpractice 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. Why Is Provider Credentialing Important?

Malpractice 52

Malpractice Due Diligence Compliance Licensing 52

Verisys

SEPTEMBER 18, 2023

Best Practices for Healthcare License Monitoring Did you know that for every 1,000 licensed healthcare practitioners there will typically be 20 with inactive licenses, 10 with a suspended license, and another six practitioners with either a restricted or revoked license, or on probation?

Licensing 52

Licensing Malpractice Compliance Hospitals 52