Episode 1:
Medicare Credentialing Guide for Private Practices
Understand how private therapy practices can complete Medicare credentialing step by step, from obtaining an NPI and submitting the CMS-855I application through PECOS to receiving a PTAN and enrolling for electronic claims. It highlights common mistakes such as data mismatches, missing forms, and ignoring MAC requests, which often delay approval.
Episode 2:
Aligning Credentialing with NCQA Standards
Know more about how healthcare organizations must align their provider credentialing processes with the stringent standards set by the NCQA (National Committee for Quality Assurance). Compliance is critical for maintaining healthcare quality and patient safety, referencing the NCQA’s 2025 updates, which emphasize shorter verification timelines, such as reducing initial credentialing to 120 days for accredited entities.
Episode 3: Avoiding SAM.gov Exclusion Risk in Clinic Credentialing
This podcast explains that therapy clinics billing federal programs like Medicare and Medicaid must regularly check the SAM.gov database and the HHS Office of Inspector General’s List of Excluded Individuals and Entities to prevent penalties. Failing to screen all employees against these lists constitutes a serious compliance failure that can result in massive fines and the revocation of billing privileges. Know more about monthly screening of both federal lists and relevant state Medicaid lists.
Episode 4: SAM.gov and OIG Monitoring for Practice Protection
This edpisode focuses on the critical need for healthcare providers, particularly small clinics, to perform regular monitoring of federal exclusion lists. It stresses that being listed on either SAM.gov (System for Award Management) or the HHS Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) immediately bars any federal reimbursement, which can lead to severe financial penalties or the revocation of Medicare/Medicaid billing privileges.
Episode 5: Five Signs Your Therapy Clinic Needs Credentialing Help
Discover the five warning signs that your therapy clinic needs credentialing support, from repeated claim denials to delays in insurance enrollment and outdated provider information. Learn how these issues can lead to revenue loss, compliance risks, and administrative strain. Find out how expert credentialing assistance can simplify your workflow and keep your clinic running smoothly.
Episode 6: Credentialing Roadblocks for Clinic Expansion
Know more about the common credentialing roadblocks that therapy clinics, specifically those for physical, occupational, and speech therapists, face when expanding to a new location. The podcast talks about the ten critical realities, such as the need to start credentialing immediately upon signing a lease and the wildly inconsistent timelines of commercial and government payers, that can cause revenue delays and denied claims.