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Showing Posts In "Healthcare Screening, Credentialing & Exclusion Screening" Category

How a Higher Standard of Screening Can Keep Your Healthcare Business in Compliance

As the COVID-19 pandemic has demonstrated, the service that healthcare professionals offer to United States citizens is crucial to a thriving American society. Organizations that employ workers in this sector should perform their due diligence to ensure that each of their providers/practitioners is properly licensed, have a clean history with their licensing board, and are […]

Overcoming the 5 Most Common Healthcare Screening and Monitoring Challenges

Every healthcare organization has its own unique background screening challenges and needs, impacting its ability to hire top talent while remaining compliant with regulations. What background screening obstacles are you running into?

Sterling’s Healthcare and Life Sciences division has compiled a list of the five most common monitoring and background screening challenges that we’re seeing health […]

Is Your Medical Credentialing Taking Too Long?

Verifying a provider’s credentials can be a time-consuming process, but it is essential to confirm a provider’s education, professional license and certifications, medical training, work history, references and more. Rigorous credentialing allows a healthcare facility to remain compliant with regulatory bodies, such as the National Committee for Quality Assurance. Credentialing should be an ongoing process, […]

Ensuring Provider Directory Compliance with H.R. 133

In December 2020, the Consolidated Appropriations Act of 2021 (H.R. 133) was put into place, requiring group health plans and health insurance insurers to improve the verification and refresh process of their provider directory systems. But most health plans were unprepared to meet the requirements that were due by Jan. 1, 2022, such as verifying […]

Eight Common Physician Credentialing Mistakes

Poor execution of physician credentialing can result in serious consequences like financial losses on provider services, delays in claim reimbursements, fines or penalties, exclusion from federally funded programs, and harm to patients. To mitigate risk, organizations should avoid the following common mistakes: 1. Relying on limited staff and administration, 2. Having incomplete physician enrollment applications, […]

Best Practices for Healthcare License Verification and Monitoring

Hospitals and health care systems must be diligent in monitoring the licenses of their practitioners for new information that may prevent a physician from practicing. Continuous healthcare license monitoring can help red flag practitioners who may have a license that is invalid, suspended, or expired, or those that have a restriction placed on their license. […]

What is Physician Credentialing?

Physician credentialing, or the process of organizing and verifying the professional records that qualify a doctor to practice medicine, is critical in ensuring patient safety and risk management. A file must be maintained by organizations that includes primary source verification of the practitioner’s education, training, certificates, and licensure. The process can be challenging, however, with […]

The Credentialing and Privileging Process

In order for a physician to be permitted to practice, they must first complete the credentialing and privileging process. This verifies and assesses that a practitioner’s qualifications and license status are in good standing, and authorizes a licensed or certified healthcare practitioner’s specific scope of patient care services, and evaluates an individual’s clinical qualifications and/or […]

7 Things You Need to Know About the CMS Preclusion List

The CMS Preclusion List, which names providers and prescribers who are precluded from receiving payment for Medicare Advantage (MA) items and services or Part D drugs furnished or prescribed to Medicare beneficiaries, identifies providers according to their Tax Identification Number (TIN) level. The list was created with three main goals: 1. To ensure that problematic […]

The Importance of NCQA Certification for CVOs

NCQA certification demonstrates the reputability of an organization’s provider credentials process and also creates a pathway for a more streamlined, reliable credentialing process. Organizations are able to stay compliant with state and federal requirements and maintain their accreditation with Medicare, Medicaid, TRICARE, and other programs. Specifically, those in the industry recognize NCQUA CVO Certification as […]


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