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What You Need to Know About the Telemental Health Care Access Act of 2021

The Telemental Health Care Access Act was introduced June 15, 2021, by Senators Bill Cassidy (R-LA), Tina Smith (D-MN), Ben Cardin (D-MD), and John Thune (R-SD).  This bill would eliminate the requirement that Medicare patients be seen in person within six months of their telemental health appointment. The American Telemedicine Association (ATA), which supports this…

HOW HISTORICAL DATA CAN BE KEY TO PATIENT SAFETY

Primary Source Verification and Ongoing Monitoring is Essential to Effective Provider Credentialing and Privileging Sometimes there’s more to the picture. Thorough screening followed by continuous monitoring as part of the credentialing process is the most essential task in the process of providing quality care and protecting patients. However, in the past, without instant access to…

Exclusion Monitoring Challenges

Building an effective healthcare compliance program that meets legal, ethical, and professional standards requires developing effective processes, policies, and procedures. The OIG exclusion list is one of the sources to monitor to ensure compliance, program integrity, and patient safety. Failing to comply with federal and state regulations could result in fines, loss of federal program…

ONGOING MONITORING OF PROVIDERS AND STAFF REDUCES RISK OF EXCLUSION

CONTINUOUS COMPLIANCE = CONTINUOUS MONITORING What’s true today may not be true tomorrow. For the purposes of this article, continuous monitoring assures that those individuals and entities being monitored by healthcare delivery organizations are compliant with the bylaws, laws, regulatory and standards requirements governing the safety, security, and competence of an organization. The word monitoring…

Top Exclusion Reasons

Under section 1128 of the Social Security Act, the Office of Inspector General (OIG) has the authority to exclude certain individuals from federal healthcare programs like Medicare and Medicaid. In addition to not receiving reimbursement for services from Medicare and Medicaid, organizations that hire an individual from the List of Excluded Individuals/Entities (LEIE) – the…

OFAC Compliance

The U.S. Department of the Treasury’s Office of Foreign Assets Control (OFAC) enforces economic and trade sanctions to protect against foreign countries and regimes, terrorists, international narcotics traffickers, those engaged in activities related to the proliferation of weapons of mass destruction, and other threats to national security, foreign policy, or the U.S. economy. Although OFAC’s…

What to Watch Out for When Conducting License Verifications and Credentialing

When conducting provider license verifications and credentialing, it can be easy to miss signals that something may be amiss with a practitioner’s application. Sometimes red flags that should alert an organization to potential problems are obvious, but other times they are more subtle. In either case, it’s important for healthcare organizations to be vigilant and…

What is CVO Credentialing?

CVO credentialing refers to the use of a Credentials Verification Organization to perform medical credentialing on behalf of a healthcare practice or organization. The CVO verifies a provider’s credentials by obtaining primary source verification of a provider’s qualifications on the organization’s behalf. Upon verification, a provider may then enroll in payers’ health plans so that…

Recent Provider Fraud Lawsuits

Although laws and regulations impose strict compliance requirements for healthcare entities, some providers still attempt to defraud patients, private insurance companies, and federal health plans. These recent lawsuits from the first months of 2021 demonstrate the importance of thorough credentialing in the hiring and retaining of healthcare providers and careful monitoring of national databases for…

What Is SAM.gov?

The System for Award Management (SAM) is an official website of the U.S. government. Managed by the General Services Administration (GSA), SAM.gov is free for entities to: Register to do business with the U.S. government Update or renew their entity registration Check the status of an entity registration Search for entity registration and exclusion records…