Say hello to smarter physician monitoring.
We deliver smarter, more actionable monitoring across your referring, ordering, and prescribing provider networks to ensure continuous compliance.
Simplify the complexity of monitoring your physician populations.
We automate the process of ensuring your referring and ordering providers are always in good standing with Medicare and Medicaid.
Healthcare organizations may be subject to Civil Monetary Penalties liability should they provide services at the medical direction or on the prescription of an excluded person. The OIG recommends monthly monitoring for exclusions of all physicians and contracted providers. Our solution automates ongoing exclusion checks to ensure no referring, ordering, or prescribing providers are excluded by any state or federal primary source.
Medicare and Medicaid
CMS is the Federal agency that administers the Medicare program and monitors the Medicaid programs run by each state. To obtain reimbursement from Federal healthcare programs, a physician must 1) obtain an NPI; 2) Enroll in Medicare via PECOS; and 3) Enroll in each state’s Medicaid program individually. Ensuring that every provider in your physician network is in good standing with Medicare and Medicaid, has an active and valid NPI, and has not opted out of Medicare is a critical component of effective physician monitoring.
The Drug Enforcement Administration (DEA) is a Department of Justice agency responsible for enforcing the Controlled Substances Act. Physicians apply for a DEA number that authorizes individuals to write prescriptions for controlled substances, which must be active and valid before a prescription can be filled. Effective physician monitoring incorporates continuous DEA monitoring and validation to ensure compliance and avoid liability.
In addition to exclusion monitoring and validating NPI numbers, ongoing physician monitoring includes continuous credentialing of medical licenses and credentials, sanction screening, DEA and FDA monitoring, and provider data accuracy. Continuous monitoring of referring and ordering physicians ensures continuous compliance across every physician population.
Customize Physician Compliance Requirements
Your physician populations require nuanced, individual attention to ensure your organization meets every compliance requirement for every business unit, down to the individual provider. We map our monitoring solution to the unique hierarchy of your physician populations and ensure every provider has the necessary credentials, compliance status, and data needed to refer and order healthcare services.
Ongoing OIG Exclusion Monitoring for Every Provider
We automate continuous exclusion monitoring across your entire provider network. Our exclusion matching algorithm compares information from multiple databases and registries to find exact matches. We enhance primary source data with unique identifiers that complement the screening process, allowing us to find exclusions and sanctions that other solutions miss.
Validate Your Referring Providers Against NPPES
Using NPI numbers and NPPES data, coupled with our smarter data, we develop a holistic monitoring profile for every provider to ensure continuous compliance. We leverage our enhanced provider data to establish a monitoring baseline for your referral network that includes ongoing NPI, licensure, sanction, and exclusion status.
Manage All Physician Populations
We’ve designed actionable, insightful dashboards for managing your entire network of providers from one place. Ensure your physician populations meet compliance requirements across all networks. Customized dashboards and tiered views allow for reporting, managing, and interacting with every line of business, every physician network type (outpatient, attending, ordering, etc.), and every individual provider.
Custom Monitoring Solutions, Tailored to Your Organization
We develop flexible solutions unique to the needs of your provider network. You tell us the specific compliance requirements down to the provider type, and we’ll map our monitoring to meet your needs precisely. Even better – we’ll let you know if members of your physician population have missing or expired credentials on an ongoing basis.
CMS Preclusion List, DEA, NPI, and TIN Validation
Different business units across different physician networks require screening against multiple primary sources, such as the CMS Preclusion List. We aggregate the primary sources you need to monitor every physician network with its unique compliance requirements.
Physician Monitoring FAQ
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to healthcare providers in the United States by the Centers for Medicare and Medicaid Services (CMS), and is obtained through NPPES. Having an NPI number is required to enroll in Medicare through PECOS.
The NPPES assigns a unique national provider identifier (NPI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which mandated the standard unique identifier for healthcare professionals, replacing the Unique Provider Number (UPN). PECOS is a centralized national data repository established by the Centers for Medicare and Medicaid Services (CMS) for Medicare enrollment information utilized by Medicare Administrative Contractors throughout the country. Medical providers must register through NPPES first to get an NPI number before they can enroll in Medicare through PECOS.
Yes. The latest Special Advisory Bulletin issued by the OIG states “Healthcare organizations may be subject to Civil Monetary Penalties liability should they provide services at the medical direction or on the prescription of an excluded person, even if the excluded person does not receive payments from the provider for his or her services (e.g., a non-employed excluded physician who is a member of a hospital’s medical staff).” In addition, the OIG recommends monthly monitoring of referring, ordering, and prescribing physicians, in accordance with the update frequency of the OIG LEIE (List of Excluded Individuals and Entities).
A list of providers and prescribers who are precluded from receiving payment for Medicare Advantage (MA) items and services or Part D drugs furnished or prescribed to Medicare beneficiaries.