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.

Doctors 52

Doctors Malpractice Licensing Medical Billing Outsourcing 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

APRIL 18, 2024

Here are some of the most common challenges for behavioral health credentialing and Medicare enrollment: Understanding Medicare Requirements: The Center for Medicare and Medicaid (CMS) divides counselors into two main categories: marriage and family therapist (MFT) and mental health counselor (MHC).

Medicare 52

Medicare Medicare Licensing Compliance 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.

Licensing 52

Licensing Governance Compliance Fraud 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

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.

Licensing 52

Licensing Malpractice Medicaid Medicaid 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

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.

US Department of Health and Human Services 52

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

Medicaid 52

Medicaid Medicaid Medicare Medicare 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.”

Telemedicine 59

Telemedicine COVID-19 Compliance Informed Consent 59

Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”).

Medicare 40

Medicare Medicare Licensing Malpractice 40

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.

Malpractice 52

Malpractice Medical Billing Outsourcing Governance Patient Satisfaction 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. Department of Health and Human Services, Statewide Medicaid Managed Care, Florida Department of Agriculture and Consumer Services, or another agency to continue to process your complaint.

Doctors 52

Doctors Malpractice Licensing Medicaid 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.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Verisys

MARCH 1, 2022

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

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.

Malpractice 96

Malpractice Licensing Due Diligence Hospitals 96

AIHC

APRIL 25, 2022

As AIHC advises, another resource is legal advice through your malpractice insurance company. When telehealth is used, it is considered to be rendered at the physical location of the patient, and therefore a provider typically needs to be licensed in the patient’s state. Click Here for Cross-State Licensing information.

HIPAA 52

HIPAA Compliance COVID-19 Compliance Officers 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 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

Hall Render

JUNE 10, 2022

CMS updates Medicaid eligibility standards. Medical malpractice trends in Northwest Arkansas. Florida hospital offers to discharge alleged malpractice victim’s bills in exchange for silence, daughter says. New Hampshire hospital leaders’ licenses suspended amid probe of missing fentanyl. CALIFORNIA. NEW JERSEY.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

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

Medisys Compliance

MARCH 23, 2023

Provider credentialing involves verifying and evaluating the mental health provider’s education, training, certification, and licensing to ensure that they meet the standards and criteria of the insurance company, regulatory bodies, and other organizations.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Malpractice Health Insurance 52

Hall Render

DECEMBER 22, 2023

governor pushes new Medicaid expansion proposal with work requirement Missouri state senator wants voters to have say in KU Health System, Liberty Hospital merger Kansas ACLU request to halt excessive wait times at Larned turned down by judge ‘Who cares about us? health care spending hits $4.5 health care spending hits $4.5

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

MARCH 3, 2023

million for youth mental health care KENTUCKY Pike County nursing home officials release statement following loss of Medicare agreement Three Humana executives drop $11.2M million for youth mental health care KENTUCKY Pike County nursing home officials release statement following loss of Medicare agreement Three Humana executives drop $11.2M

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

MedTrainer

OCTOBER 26, 2023

ProviderOne: ProviderOne system is the system used by the Washington State Health Care Authority to enroll providers and pay claims for Apple Health (Washington’s Medicaid). Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags.

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52

Hall Render

DECEMBER 1, 2023

with more than 5 Magnet designations Four more years: Anthem Blue Cross and Blue Shield, Wellstar re-up contract Hospital fails to dodge $10M malpractice verdict after attempting to pin payment on radiologist New survey reveals insight into Georgia’s maternal health crisis New chief medical officer hired for St.

Nursing Homes 40

Nursing Homes Nurses Ransomware COVID-19 40

Hall Render

JULY 22, 2022

Delaware Adds Centene Plan to Medicaid Managed Care Offerings. Key advocates reflect on Hawaii postpartum Medicaid coverage extension. State settles University of Iowa medical malpractice lawsuit for $7.5 Board suspends nurse’s license 17 months after arrest in stabbing incident. Ground broken for Milton medical pavilion.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

SEPTEMBER 23, 2022

Aspen U surrenders nursing program license. Aspen University in Phoenix surrenders nursing program license, failing to meet NCLEX first-time pass rate. A federal judge schedules a hearing on Florida’s Medicaid transgender rule. 2 companies granted licenses to produce medical cannabis in Georgia. MISSISSIPPI.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

OCTOBER 6, 2023

Tammany Health System create new residency program CHRISTUS nationally recognized for high-quality heart care Behind Ochsner LSU Health’s multimillion-dollar tech upgrades MAINE Millinocket hospital schedules renovation after $3.5M medical school to revamp philanthropic efforts Sage Health opening 3 central Md.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

OCTOBER 6, 2023

Tammany Health System create new residency program CHRISTUS nationally recognized for high-quality heart care Behind Ochsner LSU Health’s multimillion-dollar tech upgrades MAINE Millinocket hospital schedules renovation after $3.5M medical school to revamp philanthropic efforts Sage Health opening 3 central Md.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

JANUARY 19, 2024

Francis emergency room KENTUCKY Apollo’s 220-hospital ‘stranglehold’ harms patients and workers, report alleges Humana cuts ‘small’ number of jobs in multiple locations LMU School of Nursing will open Lexington site at CHI Saint Joseph Health Mercy Health announces acquisition of orthopedic center in Paducah, Ky.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

APRIL 1, 2022

Arizona extends temporary licenses for healthcare workers. Governor Ducey Signs Bill Extending Temporary Health Care Professional Licenses. Ducey signs bill extending temporary health care worker licenses in Arizona. Lawmakers not giving up on bill to expand Medicaid to undocumented kids. Now it’s being replaced.

COVID-19 40

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