Medicaid certification for network adequacy is entering a new era of regulation. Beginning in 2026, health plans face stricter federal standards, independent validation requirements, and continuous monitoring expectations that change how organizations demonstrate...
For healthcare compliance leaders, exclusion screening is not a routine administrative task; it is one of the most scrutinized elements of regulatory oversight. Civil monetary penalties, repayment exposure, audit findings, and reputational risk often trace back to one...
Healthcare organizations that employ or contract with excluded individuals face severe civil monetary penalties, repayment of all associated claims, and potential loss of Medicare and Medicaid participation. The stakes are clear: exclusion screening is not optional...
Why Eligibility and Payment Integrity Matter More Than Ever Every improper payment tells a story, not just about a claim, but about the controls behind it. For health plans, eligibility and payment integrity are no longer back-office functions. They are board-level...
Hiring a new practitioner is a complex process for many healthcare entities. A physician onboarding checklist can help guide this process by clearly outlining the key steps required to onboard a new provider. For a physician or nurse signing on as a new provider,...
