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

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. Background Checks. Payer Enrollment.

Licensing 52

Licensing Medicaid Medicaid Malpractice 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

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

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

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

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. 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.

Telemedicine 59

Telemedicine COVID-19 Compliance Informed Consent 59

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

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.

Governance 52

Governance Licensing Malpractice 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. The following items are required for enrollment in Medicare: A primary place of service must be in operation.

Medicare 52

Medicare Medicare Medicaid 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.

Licensing 52

Licensing Compliance Malpractice 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.

Malpractice 52

Malpractice Medical Billing Outsourcing Governance Patient Satisfaction 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.

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 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

DECEMBER 22, 2023

health care spending hits $4.5 Million in Retaliation Suit John Muir, Tenet scrap hospital deal after FTC challenge Kaiser to lay off 79 administrative employees Leaning toward big wins in schizophrenia and vaccines, venture group raises new fund of $389 million Madera hospital creditors want to be paid, including CEO. 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

Hall Render

OCTOBER 6, 2023

Mary’s ‘modernization’ project UChicago Medicine AdventHealth Bolingbrook Hospital Names New CFO Nurses asks lawmakers for staffing mandates, hospital leaders disagree Loyola Medicine Burr Ridge outpatient medical center trades for $59.95

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

Mary’s ‘modernization’ project UChicago Medicine AdventHealth Bolingbrook Hospital Names New CFO Nurses asks lawmakers for staffing mandates, hospital leaders disagree Loyola Medicine Burr Ridge outpatient medical center trades for $59.95

US Department of Health and Human Services 40

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

Hall Render

JULY 22, 2022

CMS releases Medicare OPPS and ASC proposed rule. Long Beach Memorial avoids losing Medicare funding after serious patient care lapses. Delaware Adds Centene Plan to Medicaid Managed Care Offerings. Key advocates reflect on Hawaii postpartum Medicaid coverage extension. CMS pitches outpatient payment rule. CMS proposes 2.7%

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. Colorado senior-care company pauses expansion into Indiana after Medicare audit. A federal judge schedules a hearing on Florida’s Medicaid transgender rule.

COVID-19 40

COVID-19 Nurses Nursing Homes 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

Verisys

MARCH 30, 2023

How to Better Protect your Organization Through Medical Credentialing Medical credentialing – the tedious but necessary process of verifying a provider’s credentials, including license(s) and exclusion status, education, and training. Medical credentialing , unfortunately, isn’t one-and-done at the time of hire.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Hall Render

APRIL 14, 2023

But hospitals say they can’t afford to pay California hospital nurses to receive raises of up to 30% California pharmacist pleads guilty to multi-year Medicare fraud scheme Carmichael-based Eskaton pays $5.5

Nursing Homes 40

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

Hall Render

APRIL 29, 2022

Hospitals sue HHS over Medicare billing calculation. Permanent telehealth expansion could cost Medicare $25B over 1 decade. Alabama Medicaid enrollment increases as pandemic requirement continues. California to increase awards in medical malpractice cases. in malpractice case. Family nurse practitioners.

COVID-19 40

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