The Health Law Firm Blog

APRIL 19, 2024

Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.] Indest III, J.D.,

Malpractice 52

Malpractice Overpayments Overpayment Licensing 52

The Health Law Firm Blog

JANUARY 24, 2023

Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.] Indest III, J.D.,

Malpractice 52

Malpractice Overpayments Overpayment 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.

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Fraud Compliance Medicaid Medicaid 98

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.

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Compliance Malpractice Fraud Licensing 52

Verisys

FEBRUARY 3, 2025

As a healthcare provider, whether a physician, nurse, or specialist, obtaining medical licenses and completing the credentialing process are essential. This includes verifying qualifications, submitting proof of malpractice insurance , and ensuring compliance with all healthcare regulatory compliance standards.

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Malpractice Regulatory Compliance Licensing Compliance 52

Provider Trust

JULY 8, 2022

A holistic approach to exclusion monitoring and license verifications must include monitoring of disciplinary databases such as the National Practitioner Data Bank (NPDB). Department of Health and Human Services (HHS) and contains medical malpractice payments and adverse action reports on healthcare professionals.

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Licensing Malpractice Fraud Medicaid 52

MedTrainer

MAY 7, 2024

Here are the key steps: Gather Training and Education Gather Licensing and Certification Gather Work History Details Gather Payer-Specific Requirements Following Application Submission Get the tools you need to eliminate delays in your provider enrollment process.

Malpractice 52

Malpractice Licensing 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.

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Malpractice Licensing Due Diligence Hospitals 52

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.

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Malpractice Licensing Due Diligence Hospitals 52

Medisys Compliance

MARCH 21, 2023

By credentialing doctors, insurance companies can ensure that their customers receive high-quality care and that the doctors they work with are qualified and licensed to provide the care they need. By verifying a doctor’s credentials, insurance companies can mitigate the risk of malpractice claims and ensure patient safety.

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Doctors Malpractice Licensing Medical Billing Outsourcing 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.

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Due Diligence Malpractice Licensing Hospitals 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. Liability issues can even result in the termination of their license. You can also see Medicaid covered patients but each state has different rules regarding the retro-billing for Medicaid.

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Malpractice Medicare Medicare Medicaid 52

Verisys

AUGUST 17, 2023

This helps guarantee that all practitioners in your organization meet the requisite licensing and certification requirements. Mitigating liability and legal risks Malpractice claims and legal disputes can financially and emotionally drain healthcare providers and organizations.

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Malpractice Licensing Compliance Medicaid 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

JANUARY 19, 2022

Ensures proper credentialing and privileging of the licensed medical staff. 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. Human Resources.

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

MedTrainer

JANUARY 13, 2025

This includes all credential types: license to practice, board certification, work history, malpractice history, state licensing sanctions, and both Medicare/Medicaid sanctions and exclusions. This doesnt call for monthly monitoring of all credential information only monthly monitoring of the license expiration date.

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Licensing Malpractice Medicaid Medicaid 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. Payers in New Jersey have specific requirements.

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Licensing Medicaid Medicaid Malpractice 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 practitioner must provide a license to practice. CMS has also waived certain requirements during the COVID-19 crisis.

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Hospitals COVID-19 Licensing Medicare 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.

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Malpractice Fraud Licensing Compliance 52

MedTrainer

MAY 29, 2024

One of the newest changes that impacts medical credentialing services in Oklahoma is a major change to SoonerCare, the state’s Medicaid program. Controlled Dangerous Substance (CDS) Required The Oklahoma State Bureau of Narcotics and Dangerous Drugs Control requires registration as well as a controlled dangerous substance (CDS) license.

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Licensing Medicaid Medicaid Malpractice 52

MedTrainer

MAY 15, 2024

Florida Medicaid Portal The Florida Medicaid Web Portal is very specific and if you aren’t familiar with submitting the documentation, it is easy to make a wrong turn. Providers must first submit their Medicaid enrollment application and receive the Application Tracking Number (ATN) before they can access the clearinghouse.

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

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Malpractice Medicaid Medicaid Licensing 52

MedTrainer

OCTOBER 29, 2023

The Colorado Medical Board oversees medical credentialing and licensing within the state. 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.

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Licensing Malpractice Medicaid Medicaid 52

MedTrainer

MAY 29, 2024

No Medicaid Identification Numbers As of September 1, 2021 , Texas stopped assigning Medicaid identification numbers, formerly known as a “TPI number.” If the provider will be enrolling with Medicare and the Texas Medicaid program , you’ll also want to set up the Provider Enrollment and Management System (PEMS) profile.

Medicaid 52

Medicaid Medicaid Malpractice Licensing 52

MedTrainer

MAY 6, 2024

Here are the key steps: Gather Training and Education Gather Licensing and Certification Gather Work History Details Gather Payer-Specific Requirements Following Application Submission Get the tools you need to eliminate delays in your provider enrollment process.

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Licensing Malpractice Health Insurance 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.

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Licensing Compliance Malpractice Medicaid 52

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses.

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Licensing Governance Compliance Fraud 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.

Licensing 52

Licensing Malpractice Medicaid Medicaid 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

AIHC

SEPTEMBER 5, 2023

Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This is also called “store-and-forward telemedicine.”

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COVID-19 Telemedicine Informed Consent Compliance 59

Physician Credentialing Company

OCTOBER 25, 2024

For example, a psychotherapist who has a professional practicing license might embrace the cognitive-behavioral approach to urge the patient to overcome negative thinking methods. Only licensed mental health professionals are permitted to send the bill for the services offered defined by code 90834. Who can Bill CPT Code 90834?

Licensing 52

Licensing Medical Billing Telemedicine Medicare 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

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.

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Medical Billing Outsourcing Malpractice Governance Patient Satisfaction 52

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. High number of malpractice cases. Software options to ensure provider data integrity and optimized enrollment management.

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Medicare Medicare Medicaid Medicaid 52

MedTrainer

MARCH 5, 2025

Imagine discovering your surgeon’s license expired six months ago, or learning that your hospital is losing millions in revenue because of inaccurate details that cause denied claims. Missing a single expired license or skipping one background check can lead to denied claims, legal liability, and damaged reputations. With 75.7%

Licensing 52

Licensing Compliance Malpractice Medicare 52

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

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.

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Malpractice Due Diligence Compliance Licensing 52