Credentialing and Re-credentialing

The process through which an organization (e.g., a hospital, insurance network, clinical practice, or physician group) decides whether a candidate is qualified to render acceptable quality of care to patients. Credentialing focuses on the collection and verification of information. Credentialing is somewhat confused with enrollment. In order to make sure you are enrolled and credentialed properly it is important to understand the difference between the two.

OIG Exclusion & CMS Monitoring

The federal mandate states, “if you are terminated in one state Medicaid, you are terminated in all states.” 

Generally speaking, according to OIG and CMS it is your duty to make a monthly routine check about your employees and vendors. An excluded provider can be charged as high as $10,000 per item claimed per day by CMS when you submit a bill to them.

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