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Beyond Credentialing: Are you prepared to operated in an increasingly transparent healthcare system?

Learn how to navigate and eliminate the increase risk your organization is exposed to now with the new PPACA laws and CMS rules. 

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2011 is Year of OIG Enforcement and National Sanction Search

"As of January 1, 2011, the Employer must conduct a search of each and all State Medicaid Action(s) to determine if a licensee has been excluded or terminated from a Medicaid program…A thorough license and sanction searches should be performed to cover all states and federal exclusions, on a routine basis. Routine is defined as no less than once a month. Best practice is to conduct ongoing monitoring. This is a drastic change in Liability of Healthcare Organizations and required screening and monitoring."

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PPACA/CMS Final Rules and Guidelines

"The Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “PPACA”), contains numerous provisions related to health care fraud and abuse and program integrity. The ACA went into effect January 1, 2011. The CMS Final Guidelines and Rules take effect March 25, 2011. The fraud and abuse provisions will have a significant impact on the compliance programs of health care organizations."

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White Paper: Compliant Continuous Monitoring

"Ongoing monitoring, looking at the status of a provider’s credentials on a defined schedule (e.g. monthly) is a best practice. Ongoing monitoring should look at, where applicable, DEA, license and sanction status at the highest possible frequency based on data update schedules at the State and Federal level. Since many agencies may report the same event over time, the first indicia of trouble would generally be caught in an ongoing monitoring program allowing the subscriber to act proactively when an adverse event surfaces."

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Links

  • CMS Final Rules - Vol. 76 No. 22 - The Patient Protection and Affordable Care Act made a number of change to the Medicare, Medicaid and CHIP programs designed to combat fraud, waste and abuse. Effective March 25, 2011, various screening tools, including unannounced site visits and criminal background checks may become standard procedure when a provider or supplier enrolls or re-validates their participation in these programs.  
  • HHS/CMS Final Rules January 24, 2011- CMS Final Guidelines and Rules for ACA compliance take effect March 25, 2011
  • PPACA CMS Provisions- All CMS related sections of the Patient Protection and Affordable Care Act
  • Memorandum Report - August 5, 2008 - About Two-Thirds of Providers With Final Actions Imposed by State Medicaid Agencies in 2004 and 2005 Were Not Found in the Exclusions Database State Medicaid agencies reported taking 4,319 final actions against providers in 2004 and 2005. Of these, 61 percent were not found in the exclusions database.
  • NLCA- Nurse Licensure Compact Administrators: - The following link has tables and maps that indicate the 24 states which have enacted the Nurse Licensure Compact (NLC).
  • The Tennessean: - Dozens of Tennessee nurses have had their licenses suspended for ignoring their student loans.
  • ProPublica - Article - California's registered nursing board has discovered that some 3,500 of its nurses have been punished for misconduct by other states — hundreds even had their licenses revoked — while maintaining clean licenses in the state.
  • Health Resources and Services Administration (HRSA) - National Practitioner Data Bank (NPDB) - U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) has undertaken efforts to improve the completeness and accuracy of data reported to the Healthcare Integrity and Protection Data Bank (HIPDB) and the National Practitioner Data Bank (NPDB).
  • OIG - The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452 (as amended), is to protect the integrity of Department of Health and Human Services (HHS) programs, as well as the health and welfare of the beneficiaries of those programs.
  • Real Nurse- Nursing Directory - Resources for nurses.

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