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Hi everybody. This is Perry Barnhill with the Fearless Acupuncturist. Today we are gonna talk about OIG and an exclusion list and what it means to you and why you need to be aware of it. Wanna give a big thanks to the American Acupuncture Council? Go to slideshow please.
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Okay, here we go. Understanding and using the OIG exclusion list. This is about performing certain exclusion checks. On your staff regarding the Office of Inspector General. Let’s talk about that. This is something that we want to check every single month. Now put it in perspective here for you.
We got Health and Human Services at the top, HHS, you’ve heard of that. And then we have OIG, the Office of Inspector General. Now they’re very closely related to the OCR, which is the Office of Civil Rights, and this is where all the HIPAA stuff comes in. These two are basically sisters to each other, and they’re so important that you need to be aware of.
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That’s why we’re talking about this right now. What is the OIG exclusion list and why do we need to check it? Okay, so here’s what it is. The exclusion list is a list of individuals that the government collects that basically shouldn’t be employed in your office. If you’re accepting any federally funded programs such as Medicare, for example, or even if you’re in some acupuncture networks for P-P-O-H-M-O or insurance networks.
Now, if they’re on this list. Is something we need to be aware because we may not keep them employed. This is something we want to ensure compliance with Medicare, Medicaid, like I said, certain contract requirements by regularly verifying employees. Who do we need to check? Okay, now everybody that we need to check is pretty much anybody in our office that’s involved in any kind of patient care or has any kind of access to protected health information.
So you got your staff that’s involved with your patient care. Any employees handling any kind of billing procedures or protocols, personnel. Anybody who has access to protective health information, I’m not talking about a janitorial service or a cleaning service. Those folks though, if you don’t know already, they need or you need to have them fill out certain forms such as non-disclosure statements and agreements.
Because even janitors that come into our office may accidentally see protected health information. And that’s something just on a side note that you need to be aware of and you should have protected and you should be speaking to them about. The Medicare exclusion list. This is a list of an OIG website that I want you all to go to.
Here it is exclusion dotig.hhs.gov. You need to go here, and this is where you need to start doing some check-in. Go in there and enter your employee’s last name and first name, and if you need to, because some people have similar names or same names, use additional details such as their date of birth. If you have other providers in the office, you need to check on them as well to narrow the results.
So how do we interpret these results if their name actually pops up? The good news is if it doesn’t pop up, they’re good to go. You don’t need to worry about it, but if one of your employees or your personnel’s name pop up, make sure you click to verify and redo, review additional details again to make sure it’s not the same person that you have in your office.
So you can enter date of birth NPI numbers if they’re providers for confirmation. And believe it or not, there’s another exclusion list that I want you to check. Even though I’m talking about this and there seems like it’s overwhelming, at least a little bit. It’s easy. It’s very fast. You literally go to those websites, you check in their names.
It pops up very fast, and their name’s either on there or it’s not on there. I. The other one is the SAM exclusion list. This is the next website you want to go to and just double check and make sure nobody in your office is on this list. sam.gov. Just go there. Check how to search is very similar.
You use the entity verification search function and again, you enter the information of the employee’s name or any personnel that you have in your office to make sure they’re not on that list. Some verification tips. Provide as much identifying information as possible. Again, to make sure maybe you got two people with the same name, confirm the details and make sure that they match.
The last thing I want y’all to check is your state-based exclusion checklist. So we got the government, we got the SAM list and then also double check any kind of exclusion list. And again, just to reiterate this, if you accepting any federally funded programs, you have to make sure that none of your employees or anybody in your office is on this list or even other providers.
’cause if they’re on this list and you hire them and they’re employed and they find out. You can get in some big trouble and the fines are pretty steep. So again, where to check for state specific list? Use your state specific portal. Alrighty, and make sure that they’re not on that list as well. How to search?
Very similar. Locate the sections for OAG provider sanctions and you enter your employee’s name and other identifying details if needed and if possible, reviewing the information. Check details again to ensure that it matches the individual. Again, making sure it’s not the person in your office. Maybe they got a same name, and I know I said that a thousand times, but just double check.
Note any active sanctions or exclusions relative to state Medicaid programs. Here’s some best practices for verification. Always verify with multiple data points for the reasons we’ve just talked about. Cross-reference your results. Check the OIG, the Sam and State Base to confirm accuracy and just as important, make sure you document everything as if it’s not documented, they will say, you never ever did it. So make sure you do that and make sure you do it monthly. The importance of regular exclusion lists, compliance meets Medicare, Medicaid, and also many insurance contracts. You have to make sure they’re on this list. Risk management helps prevent potential fraud and abuse.
’cause if those folks are on this list, it’s likely they have some kind, they’ve been convicted of some kind of criminal action, and there’s something going on that you definitely may not want them in your office. All right? Quality insurance ensures that other qualified personnel have access to sensitive patient care and information.
So you gotta be safe there. You gotta protect that information. So here’s some next steps. Just to recap, use OIG website and Medicare exclusion list checks to make sure they’re not on the list. The SAM exclusion list. And also check your state. Record this in your manual. Make sure you record it in your manual.
’cause again, like I said, if it’s not checked, it’s not done and you need to do it monthly. It doesn’t take long. So just make sure you get in there and you get that done. Additional resources, I’ve went over these, but here’s a screen just to check again, different spots you can check. If you don’t know if you’re HIPAA compliant, the likelihood is that you’re probably not.
Many providers may have a form or two in the office, and they think that means that they’re HIPAA compliant. So this is why we came up with the checklist here. Go over this checklist. Look at the boxes here. If you’re not checking every box, the likelihood is very high. Likelihood is that you’re not HIPAA compliant.
Make sure you do so because the fines associated with any HIPAA noncompliance are very scary. You can scan the QR code as well. If you want to schedule a demo, you can go to fearless provider.com right here as you see, and we can go over a demo with you, show you how the program looks, what exactly it looks like on the inside, how to navigate it, how to have your staff navigate if you choose not to.
If you wanna just get started, you can go to fearless acupuncturist.com. You can get started that way as well. If you want to contact me. If you wanna reach out to me ’cause you have questions or concerns or anything like that, please feel free to do i’m more than happy to jump on the phone and jump on the site, go over a demo with you and answer any questions that you may have.
You can contact me at Dr. perry@betterhipaablueprint.com. Also, you can scan the QR code here as well. If you got questions, reach out to me please. I am more than happy to help any and all of you. In the meantime, everybody, have an amazing day and we will talk to you soon.