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

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

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 Regulatory Compliance Malpractice Compliance 52

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

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

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

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 Compliance Informed Consent 59

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

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

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

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

Healthcare IT News - Telehealth

SEPTEMBER 16, 2020

Review, revise and communicate telehealth malpractice policies. Centers for Medicare and Medicaid Policy were to address these policy issues in a consistent way, she predicted, commercial insurers would likely follow suit. Provide coverage for at-home monitoring devices. " If the U.S.

COVID-19 204

COVID-19 Public Health Malpractice Telemedicine 204

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

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

MARCH 14, 2024

Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority. The specialist contacts other parties and primary sources to verify the provider’s information – prior employers, references, and educational institutions.

Malpractice 52

Malpractice Licensing Hospitals Compliance 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

MedTrainer

MAY 6, 2024

Department of Commerce National Technical Information Service (when applicable) Disciplinary history or adverse actions related to licensure and DEA registration, which we query through state licensing boards and the National Practitioner Databank (NPDB) Malpractice insurance claim history to examine any possible trends and to look for evidence that (..)

Licensing 52

Licensing Malpractice Health Insurance Medicaid 52

AIHC

AUGUST 30, 2023

For companies that fall under the regulation of billing Medicare and Medicaid, which are not under a medical exemption, they will need to be Accredited by an approved Accreditation Organization. These companies will follow policies and procedures for the Accrediting organization along with all Medicare rules and regulations for DME.

Compliance 52

Compliance Fraud Medicare Medicare 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

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. The employer may also review any pending and past medical malpractice cases or disciplinary actions. We’ll also review why both processes are vital for healthcare organizations.

Licensing 52

Licensing Governance Compliance Fraud 52

MedTrainer

OCTOBER 29, 2023

Ensure the provider’s CAQH profile is up to date and if the provider will be enrolling with Medicare and the state’s Medicaid program, called Medi-Cal , set up those portals as well. Primary Source Verification. Background Checks. Payer Enrollment.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

SEPTEMBER 2, 2022

On July 26, 2022, the Centers for Medicaid and Medicare (“CMS”) published the 2023 Hospital Outpatient Prospective Payment System (OOPS) and Ambulatory Surgery Center Payment System Proposed Rule. The Consolidated Appropriations Act, 2021, signed into law on December 27, 2020, created a new Medicare provider type called an REH.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

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

Med Law Blog

MAY 1, 2023

Please note that the potential for ulterior financial motives does not automatically presume that the intent is somehow suspect, in the same way that potential medical malpractice concerns does not legitimately question the clinical motives of all other providers.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

AIHC

JANUARY 5, 2022

These don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. The provisions of EMTALA apply to all individuals (not just Medicare beneficiaries) who attempt to gain access to a hospital for emergency care. Identify eligible cases.

Medical Billing 52

Medical Billing Health Insurance Hospitals Medicare 52

Provider Trust

APRIL 14, 2023

In addition, organizations should monitor reports about medical incidents, disciplinary action, and malpractice claims involving their providers.

Licensing 52

Licensing Compliance Malpractice Medicaid 52

AIHC

APRIL 25, 2022

As AIHC advises, another resource is legal advice through your malpractice insurance company. Medicaid programs often restrict the type of providers that can be reimbursed when delivering services via telehealth. During the COVID-19 public health emergency (PHE), many states waived this requirement or provided specific exceptions.

HIPAA 52

HIPAA Compliance COVID-19 Compliance Officers 52

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

Health Law Advisor

NOVEMBER 2, 2022

Announced in the Consolidated Appropriations Act of 2021, Rural Emergency Hospitals (REHs) will be a new type of Medicare provider starting January 1, 2023. Existing CAHs and rural hospitals with fewer than 50 beds will be eligible to convert to an REH.

Medicare 52

Medicare Medicare Hospitals Malpractice 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

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. Dansville doctor agrees to pay $600K for falsely billing Medicare, Medicaid. Arkansas receives second $786.6

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

Hall Render

MAY 13, 2022

Judge awards $5 million to NH woman in medical malpractice case. Government watchdog: Health care giants improperly denied Medicare benefits. 50 doctors urge Schrader to allow Medicare to negotiate drug prices, cease ‘false’ ads. Hospital association sues DHS over pro-union language in Medicaid contracts.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

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

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