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

Should You Run Healthcare Sanction Checks on All Your Candidates?

A healthcare or medical sanction check researches any disciplinary action placed on a healthcare practitioner and/or the healthcare entity by a state medical board, ensuring the provider doesn’t have a questionable past before hire. A few of these sanctions include medical negligence liability (when a healthcare practitioner offers substandard medical care that an equally skilled […]

Best Practices for Healthcare License Monitoring

Monthly healthcare license monitoring can help healthcare organizations stay in compliance with federal and state regulations and keep patients safe. The first step is to verify that physicians have met graduate and undergraduate education requirements. Medical licensure requirements should also be verified and monitored to watch for disciplinary actions against the license. It is also […]

The Top 5 Provider Credentialing Errors

Provider credentialing, or, specifically, medical credentialing, is the process of verifying that a provider’s qualifications are current and in good standing. Typically taking place upon hiring a new candidate and as routine practice, while the provider is employed by a healthcare organization, the process consists of confirming that the applicant’s education, work history, license, and […]

8 Simple Steps to Expedite and Improve the Provider Credentialing Process

In order to assure the provider population of a health system is qualified to practice in the areas where privileges are granted and are compliant with quality standards and regulatory requirements, the provider applicant review process should include key considerations to determine whether the candidate should proceed to the next steps. Those points are: incomplete […]

The Importance of Primary Source Verification on Provider Credentials

The medical staff services team at a hospital must properly verify a healthcare provider’s credentials for onboarding and granting privileges, including places like medical schools for the verification of completion of education, state licensing boards to verify license type and status, and NPDB for sanctions. The process can take more than 90 days, but utilizing […]

Slipping Through the Cracks: License Revocation in the Healthcare Industry

There are more than 16 million people working in the healthcare industry in the United States, according to the Occupational Employment Statistics from the Bureau of Labor Statistics, and it is critical that organizations that employ them perform their due diligence to ensure 1. Proper licensing, 2. A clean history with the licensing board and […]

What is the Process of Getting Credentialed with Medical Insurance Companies?

The process of provider enrollment can take a lot of time, but it’s the only way a healthcare provider organization can become an in-network provider and be paid by insurance companies. Requirements differ among payers, but there are three basic steps that can be taken to ensure there are no issues with cash flow or […]

What is Provider Recredentialing?

The recredentialing process, which verifies the education and training of providers and notifies healthcare organizations of abuse or fraud, while possibly burdensome to administration, can help hospitals avoid millions in civil monetary penalties, delayed reimbursement and litigation. In most states, recredentialing takes place every two years, while health plans may also have additional requirements. It […]

The Merits and Importance of Provider Credentialing

As published by the British Medical Journal (BMJ) in 2016, 250,000 deaths per annum were attributable to medical error, making this the third leading cause of death in the United States. In addition, roughly 3 to 10 percent of the entire federal healthcare funding is lost to fraud, waste, and abuse. These two topics are […]

Improving Patient Safety and Physician Accountability

According to a study by Johns Hopkins University, the third leading cause of death in the United States is medical malpractice. In response, the Department of Health and Human Services’ (HHS) guide has identified four key areas healthcare organizations should examine to prevent medical errors, including breakdowns in communication, medication-related errors, factors influencing incorrect or […]


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