Get smarter compliance insights into your ordering, referring, prescribing, and attending physician populations.
Drive operational efficiencies and align workflows between the ordering, registration, scheduling, and care teams as well as others in the revenue cycle process. Rest assured that your physician populations remain compliant.
Simplify the complexity of monitoring your non-employed physician populations.
Ensure Compliance Eligibility at Moment of First Interaction
Screen every physician instantly at the moment of first interaction to ensure compliance and billing eligibility, save your team time, and reduce the risk of no-bills. For example, automatically see screening insights during a scheduling workflow to identify excluded or ineligible providers before the patient interaction or billing eligibility issue occurs.
Instant to Ongoing Screening
Our smarter monitoring seamlessly ensures ongoing compliance requirements are met across all physician populations, including ordering, referring, prescribing and attending physicians. Our solution screens providers instantly to ensure eligibility for patient scheduling and care coordination at the time of care, and then continues monitoring the same providers against your customized desired regulatory requirements to ensure ongoing compliance and network integrity.
Configurable Physician Compliance Requirements
Your physician populations require nuanced, individual attention to ensure your organization meets every compliance requirement for every business unit down to each 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, order, and prescribe healthcare services and see patients. With the ProviderTrust platform, you can create your monitoring requirements across a variety of primary source databases including, the OIG LEIE, SAM.gov, NPPES, SSA DMF, OFAC, Medicare Opt Out, and others.
Ongoing OIG Exclusion Monitoring for Every Physician
We automate smarter ongoing exclusion monitoring across all of your physician networks. Our exclusion matching algorithm compares information from the primary source to deliver only exact matches. We enrich primary source data with unique identifiers, allowing us to find exclusions and sanctions that other solutions miss.
Meet Dash, the smarter monitoring solution for referring & ordering providers.
Dash is the customizable, ongoing compliance monitoring solution for your entire population of referring, ordering, prescribing, and attending physicians.
Resources to help your team grow & succeed.
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In this recorded webinar, we dive into the best practices for monitoring your organization's referring, ordering, and prescribing physician populations, exposing the gaps and vulnerabilities that could leave your organization and its patients open to risk.
Referring & Ordering Physician Compliance 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.