How to Screen Your Non-Employed Provider Populations

All healthcare entities are responsible for verifying that contracted, referring, ordering and prescribing physicians are not excluded on a state or federal level from providing services or they could face penalties from the Office of the Inspector General (OIG) at Health and Human Services (HHS). It is important to regularly check the List of Excluded Individuals and Entities (LEIE) database to avoid non-reimbursement and penalties. An excluded provider may refer a patient to a non-excluded provider, but the conditions under which this is legal are strict. Entities should consider keeping a record of all referring providers, classifying them by type of service and billing procedures, determining who is responsible for monitoring providers and if these processes are sufficient to meet OIG guidelines, determining how often new providers are used, determining if data collected from new providers is sufficient for screening, and finding out how often monitoring is conducted and determining if this time interval is sufficient to meet OIG guidelines.


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Post By Ken Shafton (2,372 Posts)