HHS OIG: 1 in 5 Medicare Advantage Organizations Not Using NPI for Program Integrity Oversight
HHS OIG recently released another report about Medicare Advantage organizations including NPIs within encounter data and leveraging these identifiers for program integrity oversight.
Health System Enhances NPI Validation and Referral Monitoring
We love helping our customers improve their overall healthcare compliance program. Take a look at how we enhanced this organization’s ongoing monitoring of referral networks with NPI validation.
September 2020 HHS OIG Work Plan Updates
September HHS OIG Work Plan updates include COVID-19 data and guidance, MAO provider identifier suggestions, FDA reviews, and more.
HHS OIG Recommends CMS Require NPIs for Ordering Providers
HHS OIG recommends that CMS require MAOs to submit NPIs for ordering providers. Explore the reasons why this information would be helpful to prevent FWA, and the concerns from payers in regard to the accuracy of CMS encounter data.
How to Screen Referring, Ordering, and Prescribing Physicians
Learn how to screen your non-employed provider populations (referring, ordering, prescribing physicians with NPI verification and ongoing sanction/exclusion monitoring.
Best Practices for DEA and FDA Physician Screening
Learn how to screen DEA and FDA databases for sanctioned physicians and prescribers.
How to Leverage an NPI for Provider Directory Accuracy
Learn more about the challenges of maintaining provider directories and how to utilize an NPI to fill in the gaps of provider data.
How to Lookup Physicians and Healthcare Organizations with an NPI
Discover how to utilize the NPI Registry to lookup physicians and healthcare organizations and learn how NPIs can help make your provider data smarter.
Quick Guide to Understanding National Provider Identifiers (NPI)
Most healthcare professionals are familiar with the term NPI (National Provider Identifier) because it is commonly used to validate and verify a wide range of authentication, process control, individual claims, contracts/agreements, and much more. With so many NPI searches happening on a daily basis, we want to help quickly identify the framework and functionality of […]
Three Things to Know about NPI in Healthcare
Covered entities under HIPPA must use NPI’s to identity health care providers in HIPPA standard transactions. The NPI number is required to submit claims or conduct other transactions specified by HIPPA. By definition, a health care provider” is an individual, group or organization that provides medical or other health service or supplies.” This would include physicians an other practitioners, physician/practitioner groups, institutions such as hospitals, laboratories and nursing homes, health maintenance organizations and suppliers such as pharmacies and DME companies. However, it does not include health industry workers such as admissions and billing personnel, housekeeping staff, orderlies and those who support the provision of health care, but do not provide health care services.
