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

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

JULY 28, 2023

OIG Inspections in Healthcare The OIG focuses its resources on oversight of Medicare and Medicaid — programs that represent a large portion of the federal budget. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers. What Is the Scope of an OIG Inspection?

Fraud 98

Fraud Compliance Medicaid Medicaid 98

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

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

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. Violations to these laws can result in fines, prison time, and/or exclusion from the Medicare and/or Medicaid programs.

Telemedicine 59

Telemedicine COVID-19 Compliance Informed Consent 59

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-19 199

COVID-19 Public Health Malpractice Telemedicine 199

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

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

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

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

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

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

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 97

Telemedicine Medicaid Medicaid Malpractice 97

MedTrainer

OCTOBER 29, 2023

Ensure the provider’s CAQH profile is up-to-date and if the provider will be enrolling with Medicare and Health First Colorado , set up those portals as well. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. Background Checks.

Licensing 52

Licensing Malpractice Medicaid Medicaid 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. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

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

MedTrainer

DECEMBER 20, 2023

Ensure the provider’s CAQH profile is up-to-date and if the provider will be enrolling with Medicare and Availity payers, set up those portals as well. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. Primary Source Verification.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

Medisys Compliance

OCTOBER 30, 2023

Here are the general steps involved: Gather Required Documents: Collect all the necessary documents, such as your professional license, certifications, malpractice insurance, and practice information. Complete Applications: Fill out the applications for the insurance companies you wish to contract with.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Malpractice Licensing 59

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

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

MedTrainer

NOVEMBER 27, 2023

To be eligible, hospitals must submit a complete application, be certified or accredited by the Centers for Medicare and Medicaid Services (CMS), demonstrate compliance with ODH standards, and specify bed numbers. Hospital Licensure Effective September 30, 2024 , Ohio hospitals must obtain licensure from the Ohio Department of Health (ODH).

Compliance 52

Compliance Licensing Medicaid Medicaid 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

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

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 90

Malpractice Licensing Due Diligence Hospitals 90

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

AIHC

APRIL 25, 2022

As AIHC advises, another resource is legal advice through your malpractice insurance company. During the COVID-19 PHE, the list of providers in Medicare and many state Medicaid programs expanded to include professionals such as occupational and physical therapists and speech-language pathologists.

HIPAA 52

HIPAA Compliance COVID-19 Compliance Officers 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

Hall Render

JUNE 10, 2022

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. Mercy shifts leadership structure, names Gehrig president of Arkansas hospitals.

COVID-19 40

COVID-19 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. Kim Schrier, Health initiatives, Inflation & Medicare. NEW HAMPSHIRE.

COVID-19 40

COVID-19 Nurses Nursing Homes 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 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

Medisys Compliance

MARCH 23, 2023

In our credentialing services we assist you in entire credentialing process for all insurance companies including Medicare and Medicaid.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Malpractice Health Insurance 52

Hall Render

JUNE 30, 2023

MedStar Transport Celebrates 40 years of service C.

US Department of Health and Human Services 40

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

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

Hall Render

NOVEMBER 27, 2023

Mary’s Hospital accused of negligence and medical malpractice in wrongful death suit. 11 Plan To Slash $1.5B 11 Plan To Slash $1.5B Louis health system strikes deal with southeast Missouri provider St. renovation St. cash Tenet’s $2.4B

US Department of Health and Human Services 40

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