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

HIT Consultant

FEBRUARY 5, 2024

Credentialing lapses can expose a healthcare organization to malpractice suits and accreditation problems. This creates the potential for negative patient outcomes, which can lead to expensive malpractice lawsuits. Thorough and ongoing physician screening is critical to avoid costly negligent credentialing and malpractice claims.

Malpractice 96

Malpractice Licensing Due Diligence Hospitals 96

Physician Credentialing Company

DECEMBER 27, 2024

How Much Does Medicare Pay Credited to CPT code for 99213? Over the years, one of the questions we get asked most often is, What does Medicare pay for CPT code for 99213? Medicare reimbursement rates vary slightly by geographic location and annual fee schedule updates made by the Centers for Medicare & Medicaid Services (CMS).

Medicare 40

Medicare Medicare Medicaid Medicaid 40

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

Medicare 52

Medicare Medicare Licensing Compliance 52

Verisys

MARCH 6, 2025

Mitigating Risks for Healthcare Organizations By verifying that all providers are properly credentialed, organizations minimize the potential for malpractice claims, legal disputes, and reputational damage.

Licensing 52

Licensing Compliance Nurses Malpractice 52

HIT Consultant

AUGUST 5, 2022

CMS Proposed Changes to the Physician Fee Schedule 2023 : On July 7, 2022, the CMS announced that it is soliciting public comment on proposed policy changes for Medicare payments under the Physician Fee Schedule (“PFS”) effective on or after January 1, 2023. The proposed changes would reduce the conversion factor by 4.4% from $34.61

Telemedicine 98

Telemedicine Medicaid Medicaid Malpractice 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.

Compliance 52

Compliance Malpractice Fraud Licensing 52

Physician Credentialing Company

DECEMBER 20, 2024

It acts as a shield against malpractice claims under the False Claim Act. Medicare guidelines should be checked if you are billing this payer. Medicare and Medicaid allow non-credentialed providers to get reimbursement but under strict rules. Sixty days is a consecutive limit, including the days off.

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 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. Providers are billed after getting registered with Medicare and receiving a PTAN number, but it is still better than not doing anything. How Long Does It Take To Get Credentialed With Medicare?

Malpractice 52

Malpractice Medicare Medicare Medicaid 52

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

Verisys

FEBRUARY 3, 2025

This includes verifying qualifications, submitting proof of malpractice insurance , and ensuring compliance with all healthcare regulatory compliance standards. court documents, dismissals) for all malpractice/disciplinary actions OR completion of appropriate explanation form (if applicable).

Malpractice 52

Malpractice Regulatory Compliance Licensing Compliance 52

Verisys

APRIL 3, 2025

Compliance Penalties Regulatory agencies like the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission enforce strict medical credentialing standards to ensure healthcare providers meet necessary qualifications and maintain patient safety.

US Department of Health and Human Services 52

US Department of Health and Human Services Licensing Compliance Malpractice 52

MedTrainer

MAY 7, 2024

Here is a list of the information you’ll need to gather for UnitedHealthcare credentialing: Training and Education Practitioner degree (M.D.,

Malpractice 52

Malpractice Licensing Medicaid Medicaid 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.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Verisys

JANUARY 19, 2022

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.

US Department of Health and Human Services 52

US Department of Health and Human Services Hospitals Malpractice Compliance Officers 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

Medisys Compliance

MARCH 21, 2023

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.

Doctors 52

Doctors Malpractice Licensing Medical Billing Outsourcing 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.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

Verisys

AUGUST 31, 2023

Here are seven red flags to look out for and the reasons why: Incomplete or inconsistent application: Missing or conflicting data regarding education, training, work history, licensure, or malpractice history might indicate false information or attempts to conceal relevant details.

Malpractice 52

Malpractice Fraud Medicaid Medicaid 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 distant site must be certified as a Medicare or telehealth facility. CMS has also waived certain requirements during the COVID-19 crisis.

Hospitals 52

Hospitals COVID-19 Licensing Medicare 52

Total Medical ComplianceHIPAA

JANUARY 11, 2024

These screenings search through various databases containing records of individuals or organizations barred from participating in Medicaid, Medicare, or other federal/state healthcare programs due to fraud, abuse, or other offenses. Why is Sanction Screening Vital Under HIPAA?

HIPAA 52

HIPAA Malpractice Regulatory Compliance Compliance 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.

Malpractice 52

Malpractice Medicaid Medicaid Licensing 52

Verisys

NOVEMBER 30, 2023

Credentialing lapses can expose a healthcare organization to malpractice suits and accreditation problems. This creates the potential for negative patient outcomes, which can lead to expensive malpractice lawsuits. Thorough and ongoing physician screening is critical to avoid costly negligent credentialing and malpractice claims.

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. This creates the potential for negative patient outcomes, which can lead to expensive malpractice lawsuits. The NPDB requires reporting of the following actions: Medical malpractice payments. Mistake No. Mistake No.

Malpractice 52

Malpractice Licensing Due Diligence Hospitals 52

Verisys

JULY 20, 2023

This creates the potential for adverse patient outcomes, leading to expensive malpractice lawsuits. Thorough and ongoing provider screening is critical to avoid costly negligent credentialing and malpractice claims. Mistake No. Mistake No.

Due Diligence 52

Due Diligence Malpractice Licensing Hospitals 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

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.

Malpractice 52

Malpractice Fraud Licensing Compliance 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

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.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Malpractice Governance Patient Satisfaction 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 ). Ongoing Process: Privileging is not a one-time event.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 20, 2023

Medicaid Proof of Submission Required NJ FamilyCare, New Jersey’s Medicaid , requires proof of submission for enrollment if the provider does not include a Medicaid ID in the application. 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

OCTOBER 29, 2023

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. Primary Source Verification. Background Checks. Payer Enrollment.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Verisys

DECEMBER 5, 2023

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

MARCH 1, 2022

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

APRIL 27, 2023

A single search through FACIS screens over 5,500 primary sources, including the following: License status in each US jurisdiction where one is held Exclusion from Medicaid or Medicare participation Civil and criminal background checks Specialty board certification Drug Enforcement Agency verification Malpractice certification and claims history A (..)

Malpractice 52

Malpractice Licensing Fraud Medicaid 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. Changes to credentialing application. The application attestation timeframe has been shortened considerably.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52