Essential Data Elements for Payer Credentialing

Credentialing and enrollment are critical processes that impact many facets of the healthcare industry. When not managed properly they can negatively impact a healthcare organization’s revenue. With regulatory requirements becoming more and more complex, incorrectly and poorly managed credentialing and enrollment processes also put hospitals at risk of compliance violations.NAMSS (National Organization Medical Staff Services) […]


Did you know that Medical Credentialing dates back to Persia in 1000 B.C.? To qualify for a medical license, a physician had to treat three criminals, if everyone lived, then the physician was qualified to practice medicine for the rest of his life. (Care Cloud, 2019) Thank goodness the laws around credentialing have changed drastically […]

Coding Unbundled

Coordinated Health in Pennsylvania, founded by its CEO, Dr. DiIorio, was on track to compliant coding when they hired outside consultants to audit their coding practices. The consultants found that the facility and Dr. DiIorio, a board-certified orthopedic surgeon, were misusing Modifier 59 (Distinct Procedural Service) in order to unbundle services from 2007 through 2014. […]

2017 MIPS Performance

Earlier this summer CMS released performance feedback for clinicians that participated in MIPS during 2017 performance period. This included an overview of their MIPS final score, performance category details and 2019 MIPS payment adjustment. A process called targeted review was also offered to clinicians, groups or those participating in certain APMs, to request a review […]