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What Every Credentialing Team Needs to Know About NPDB Reporting

MedTrainer

Malpractice Payments : Tracks settlements or judgments related to provider malpractice. Exclusion Checks : Lists providers barred from participating in federal (Medicare) or state (Medicaid) healthcare programs. The NPDB strictly focuses on misconduct and adverse event data, making it an indispensable tool for risk management.

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Can Your Hospital Afford Not to Outsource Credentialing?

Verisys

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.

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Understanding the Process of Credentialing Doctors

Medisys Compliance

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.

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What is Provider Credentialing in Healthcare?

Medisys Compliance

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.

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What Is Hospital Credentialing?

Verisys

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. They must also share any complaints or adverse events regarding the practitioner with the distant site.

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Understanding the Privileging Process in Healthcare

MedTrainer

Ongoing Process: Privileging is not a one-time event. 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 ).

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How To Get Ahead of the 2025 NCQA Credentialing Changes

MedTrainer

Reduce Adverse Events: Additional exclusions monitoring requirements promote faster action to prevent unintended patient incidents or quality issues. This includes all credential types: license to practice, board certification, work history, malpractice history, state licensing sanctions, and both Medicare/Medicaid sanctions and exclusions.