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Get the latest updates on news, reading resources and articles about medical licensing, credentialing and payors.

PhysiciansMartha Adams

Value-Based Care: The Future of Healthcare?

VBC is a novel reimbursement methodology linking payment directly to the quality of care provided. It functions as a promising alternative to conventional fee-for-service reimbursement, rewarding healthcare providers for efficiency and effectiveness, as opposed to the sheer volume of services.

Physicians

Value-Based Care: The Future of Healthcare?

VBC is a novel reimbursement methodology linking payment directly to the quality of care provided. It functions as a promising alternative to conventional fee-for-service reimbursement, rewarding healthcare providers for efficiency and effectiveness, as opposed to the sheer volume of services.

Credentialing

How to Connect Fragmented Provider Data and Why It Matters

Grappling with the challenge of scattered provider data is like trying to solve a complex puzzle. This data isn't just a bunch of numbers and names; it's the heartbeat of top-tier healthcare delivery. Harnessing the power of technology to bring all this data under one roof can be a game-changer.

Physicians

CMS Inpatient Payment Rule for 2024: Key Takeaway for Healthcare Organizations & Providers

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would update the Medicare inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) for fiscal year (FY) 2024. The proposed rule affects the payment rates and policies for acute care hospitals and LTCHs that provide services to Medicare beneficiaries.

Credentialing

Best Practices for Provider Recredentialing

The ongoing credentialing process, as it stands, often feels redundant and creates friction that disrupts providers' ability to manage claims, billing, and collections efficiently. It's not just costly and time-consuming; it often fails to maintain a consistent record that could enhance data integrity throughout the system.

Locum Tenens

Get Started Faster: 10 Essential Tips for Streamlining Locum Tenens Credentialing

As a healthcare professional, it's vital to keep your licenses and credentials up-to-date. Any delays or problems in the licensing and credentialing process can jeopardize the continuity of your practice. In this article, we'll share ten invaluable tips to help you streamline these processes, ensuring you avoid any obstacles that may arise.

Medical

Embracing Value-Based Care: A Shift Towards Patient-Centered Health Systems

For the past ten years, the healthcare scene has been gradually but surely embracing value-based care, a testament to the determined effort of countless professionals. This journey towards prioritizing value in healthcare isn't uniform; while some areas, like patient engagement and streamlined care coordination, have made significant strides, others, especially in leveraging data for decision-making and syncing up providers, are still catching up.

Locum Tenens

Uniform Application & Boards: A Guide for Healthcare Providers & Organizations

Uniform application is a web-based application that simplifies the licensure process for physicians, physician assistants (PAs), and residents by allowing them to apply to multiple state boards with one application. Boards are state medical and osteopathic boards that regulate the practice of medicine and grant licenses to qualified applicants.

Credentialing

13 Key Elements for Enhancing Provider Credentialing

The NAMSS specifies 13 fundamental criteria for initial provider credentialing. Discover the steps healthcare organizations need to take to streamline credentialing procedures.

Credentialing

CVO Credentialing: Enhancing Healthcare Provider Verification

As the healthcare industry becomes increasingly specialized and standards evolve, ensuring providers are adequately qualified is paramount. Credential Verification Organizations (CVOs) play a crucial role in this regard. In this article, we discuss the role of CVOs and how they can increase healthcare efficiency and lower operating costs.

Credentialing

Streamlining Provider Onboarding: Accelerating Credentialing in Healthcare

Healthcare organizations are under financial strain as they face rising costs, labor shortages, and razor-thin margins. That’s why accelerating credentialing and payer enrollment is more important than ever. The faster providers are credentialed, privileged, and enrolled, the sooner they can start delivering patient care, billing for services, and generating revenue.

Credentialing

Optimizing Credential Management: The Role of FCVS and Its Advantages

The quality and safety of patient care are significantly impacted by the accurate credentialing of healthcare professionals. Unfortunately, this process can be both daunting and time-consuming for professionals and organizations alike. However, the Federation of State Medical Boards (FSMB) offers a solution to this problem: FCVS.

Credentialing

How Credentialing Can Improve Revenue Cycle Management: A Comprehensive Guide

As the healthcare industry continues to evolve, it’s more important than ever to ensure that your revenue cycle management processes are efficient and effective. One way to achieve this is through the practice of credentialing, which is the process of verifying the qualifications and experience of healthcare professionals.

Credentialing

Enhance Your Practice: Credentialing Insights for Providers

Your team pours its heart into delivering top-notch medical care, where cutting corners just isn't in the playbook. The rigorous journey of medical credentialing underscores this commitment, guaranteeing patients can trust in the care they receive. Yet, let's face it, the admin load is hefty, swaying your team's focus from patient care to piles of paperwork. Yes, it's a drag and eats up precious time.

Payor Enrollment

Navigating PECOS: A Comprehensive Guide

In healthcare where accuracy and communication are paramount, PECOS (Provider Enrollment, Chain, and Ownership System) emerges as a crucial bridge between providers and the Centers for Medicare & Medicaid Services (CMS).

Medical

Decoding the Influence of Healthcare Regulatory Bodies

The healthcare industry operates within a complex web of regulations, which we refer to as regulatory compliance. These regulations, established by entities called medical regulatory bodies, dictate standards that ensure the quality, safety, and efficiency of health services and products.

Credentialing

Cloud-Based Medical Credentialing Software: A Game-Changer for Your Healthcare Operations

This article serves as a deep dive into the world of cloud-based medical credentialing software. We explore how this transformative technology can help tackle these challenges and offer substantial benefits to healthcare organizations. Furthermore, we will provide insights on how to select the most suitable cloud-based medical credentialing software tailored to your unique needs and objectives.

Credentialing

Healthcare Credentialing in 2023: Navigating the Landscape

For those in the healthcare sector, credentialing has always been a pivotal process, ensuring that healthcare services maintain their high standards of quality and safety. But as we move through 2023, the landscape of healthcare credentialing is undergoing significant transformations.

Credentialing

Tips for Efficient Medical Credentialing Process

Are you in search of a smarter, more efficient way to tackle the maze of medical credentialing? From initial setup to embracing automation, there’s a streamlined pathway that can make this entire ordeal far less of a headache for your team.

Payor Enrollment

Payer Enrollment vs Credentialing: The Difference and Impact

The transition to digital healthcare presents both opportunities and challenges, particularly in integrating providers into new telehealth platforms. Understanding the nuances of credentialing versus payer enrollment, including delegated and direct credentialing, is crucial for maintaining a healthcare practice's reputation and managing its revenue cycle effectively.

Physicians

A Guide to Navigating Medical License Renewal & CME Requirements

Staying current with the newest medical developments and skills is critical for healthcare professionals, striving to give excellent care to their patients. This is where continuing medical education (CME) comes in. Failing to meet renewal and continuing medical education requirements can have severe consequences, such as losing your medical license or facing disciplinary action from the state medical board. It's essential to navigate these requirements successfully to ensure the continuity of your practice and the well-being of your patients. In this guide, we'll provide you with the information and knowledge you need to confidently navigate medical license renewal and CME requirements. We'll cover everything from the basics of CME education for physicians and assistants to state-specific requirements, different types of continuing medical education events, and how to meet accreditation standards.

Locum Tenens

Master Guide for Onboarding Locum Tenens Physicians

Finding proficient physicians to meet your staffing demands may be a daunting task. Whether you are confronting a short-term vacancy, a peak season rush, or a persistent shortage, the appointment of locum tenens physicians can serve as a practical and advantageous option.

Credentialing

Mastering the Credentialing Process: Top Mistakes to Avoid for a Seamless Journey

Credentialing is a necessary and critical process in the healthcare industry, ensuring that healthcare providers are qualified to treat patients. However, the process can be time-consuming and prone to errors due to its complexity. These mistakes can cause significant problems for both the healthcare facility and the provider, with consequences ranging from delayed payments to fines and legal action. It's essential to identify and avoid these mistakes to streamline the credentialing process and ensure patients receive quality care. In this article, we'll discuss the most common credentialing mistakes and ways to troubleshoot and avoid them. So that you could successfully navigate the medical credentialing process and ensure compliance with regulatory standards.

Credentialing

Credentialing 101: Unveiling the Importance for Healthcare Providers

Healthcare provider credentialing is a process that goes beyond a simple procedure; it's a vital aspect of maintaining top-notch patient care. In this article, we will dive deep into the world of credentialing and privileging, emphasizing its significance in reducing medical errors, fostering professionalism, and improving overall healthcare outcomes.

Nurses

Understanding the Nurse Licensure Compact: A Complete Guide for Nurses

The compact nursing licenses are revolutionizing the way nurses practice and healthcare employers recruit across the United States. The compact license enables nurses to work in different states without the hassle and cost of obtaining additional licenses. This, in turn, provides healthcare employers with a larger pool of qualified nursing candidates. Navigating the NLC's intricacies can be daunting, which is why we've put together this comprehensive guide that covers everything you need to know. We discuss the basics of the multi state license, the benefits it provides, and how to obtain a new license both under the compact and by endorsement. This guide will help you make the most of the compact license. So let's dive in and make the most of this game-changing agreement!

Credentialing

Contract Nursing: A Comprehensive Credentialing Overview

Hospitals and healthcare centers often rely on contract labor, like traveling nurses, to fill their staffing needs. However, since the pandemic, the costs associated with hiring these contract nurses have risen sharply. In January 2022, contract travel nurses made up 23% of all nurse hours and nearly 40% of nursing labor costs.

Credentialing

Automating Credential Verification: A Leap Towards Efficient Provider Onboarding

Traditionally, credentialing has been a time-consuming, manual, and error-prone endeavor, often causing delays in provider onboarding and scheduling, along with the revenue that comes from patient care. However, automation is stepping in, swiftly changing the medical credentialing arena for the better. In this article, we delve into what provider credentialing entails and how automation is streamlining the process. This shift is not only enhancing efficiency and provider satisfaction but also speeding up the time to revenue for healthcare organizations.

Credentialing

Are You Overlooking Provider Data Maintenance in Credentialing & Enrollment? Here's Why It's Time to Rethink Your Approach

Picture this: You're running a thriving healthcare practice, focused on providing top-notch patient care. One day, you notice that reimbursements are taking longer than usual, and some claims are even denied. You wonder what went wrong. Could it be that you've neglected the importance of provider data maintenance in your credentialing and enrollment processes?

Payor Enrollment

Mastering Payor Enrollment: A Comprehensive Guide for Healthcare Providers and Organizations

In the swiftly changing healthcare environment, payor enrollment emerges as a critical process, pivotal for smooth medical billing and cultivating patient trust. However, its complexities often baffle many healthcare providers and organizations. This guide endeavors to clarify payor enrollment, emphasizing its importance and presenting best practices for effective navigation.

Credentialing

Decoding the Future of Healthcare Credentialing: Blockchain's Potential to Transform the Landscape

In the vast realm of healthcare, credentialing stands out as a cornerstone, validating the expertise, qualifications, and trustworthiness of professionals and institutions we rely on for our health. Far from being a mere administrative step, credentialing acts as a protective shield, a mechanism ensuring the highest standards of care that every patient rightfully anticipates.

Credentialing

Boosting the Bottom Line: How Credentialing Affects Revenue in Healthcare

We all know that thorough credentialing and privileging are crucial for patient safety. But here's something you might not expect: these processes also play a huge role in your healthcare organization's financial success. In this article, we're diving into how shrinking the time it takes to generate revenue can make a world of difference in healthcare.

Medical

Overcoming Telemedicine Licensing Barriers: How Technology is Streamlining the Process

The COVID-19 pandemic has caused a seismic shift in the way healthcare is delivered. Telemedicine has been critical in ensuring that patients receive the treatment they require, even when face-to-face appointments are not feasible. However, telehealth licensing requirements pose significant challenges for providers. Meeting them involves navigating a complex maze of regulations and guidelines, which can be both time-consuming and costly. Fortunately, technology is streamlining the process, making it easier than ever before to overcome any barrier.

Medical

Redefining Physician Assistant Roles: Insights into Career Progression and Regulatory Shifts

The role of physician associates in the U.S. healthcare system is both pivotal and growing. Since 2018, the number of certified PAs has increased by 28%, with about 12,000 new positions anticipated annually over the next ten years. These professionals have quickly become central to both specialty and primary care, proving themselves as indispensable assets

Credentialing

Importance of Primary Source Verification Credentialing

Patients entrust their well-being to healthcare providers, often at their most vulnerable times. Delivering anything less than high-quality care can lead to significant repercussions. It is for this reason that primary source verification credentialing (PSV) forms the bedrock of vetting competent healthcare professionals.

Credentialing

How to Choose the Best Healthcare Credentialing Software for Your Practice

As a healthcare provider, you're undoubtedly aware of the importance of maintaining your credentials and adhering to professional standards and regulations. Credentialing is the method of confirming and validating your qualifications, education, training, experience, and licenses required for your field of practice. This process is critical to ensuring the quality and safety of your services, as well as securing contracts and reimbursements from health insurance companies and other payers.

Credentialing

Payor Enrollment & Credentialing: Understanding the Link & Navigating the Process

Payor enrollment and credentialing are two crucial steps healthcare providers must complete to join health insurance networks and receive payment. These procedures make sure that providers follow quality standards and eligibility requirements set by health plans, as well as adhere to government program rules and policies.

Credentialing

How to Avoid Exclusions and Sanctions with Credentialing Software

How crucial do you reckon compliance is in the realm of healthcare? Compliance isn't merely a legal mandate, it's also a linchpin for trust and reputation. So if you're operating as a healthcare provider or institution, it's essential for you to understand the risks and potential fallout of breaching industry rules and regulations. Indeed, one of the most severe repercussions is facing exclusion or sanctions from federal or state agencies.

Credentialing

The Definitive Guide to CAQH: Everything You Need to Know

Every healthcare provider knows how time-consuming and tedious it can be to fill out credentialing applications for different health plans and organizations. You must repeatedly submit the same information, frequently on paper forms that are prone to mistakes and delays. Wouldn't it be good to streamline this procedure and spare you the time and hassle?

Physicians

A Professional's Guide to Managing Multiple Medical Licenses

In today's fast-paced healthcare industry, staying competitive is crucial to your career success. Holding multiple medical licenses is a proven strategy to gain an edge over your peers, yet it's often overlooked.

Payor Enrollment

Payer Contracting Trends & Insights: What You Need to Know in 2023

Payer contracting is the bedrock of negotiations between healthcare providers and insurance companies, outlining the terms of service provision and payment. The influence of payer contracting permeates every facet of healthcare, from the financial stability of healthcare institutions, and the quality of patient care, to patient satisfaction levels.

Credentialing

The Credentialing Conundrum in Rural Healthcare

In rural landscapes, where healthcare resources are already stretched thin, the challenge of credentialing emerges as a significant barrier. This process, essential for maintaining patient safety and operational integrity within medical organizations, becomes an even more formidable obstacle outside urban centers.