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OIG Self-Disclosure Protocol

By support@poweredbygnosis.com

Why Self-Disclosure Is Important The OIG has long emphasized the importance of dealing with Federal healthcare programs with integrity. All healthcare industry members have a legal and ethical duty to do so. This duty includes an obligation to detect and prevent fraudulent and abusive activities, including implementing specific procedures and mechanisms to investigate and resolve instances of potential fraud involving the Federal health care programs. Whether as a result of voluntary self-assessment or in response to external forces, participants in the healthcare industry must be prepared to investigate such instances, assess the potential losses suffered by the Federal healthcare programs,Learn MoreOIG Self-Disclosure Protocol

How to File a Complaint with Medicare

By support@poweredbygnosis.com

Medicare receives over 100,000 complaints annually. You’re not alone if you’re dissatisfied with any aspect of the federal healthcare program. You might be wondering how to express your concerns. Frequently Asked Questions What is a grievance Medicare? A Medicare grievance is a patient’s dissatisfaction with any aspect of a health care provider’s service or even the health care plan itself. It can be for reasons such as an inability to schedule an appointment with an approved Medicare provider or feeling like you were treated poorly by a doctor, nurse, or other medical staff member. How do I file a CMSLearn MoreHow to File a Complaint with Medicare

Medicare Exclusion Lists Frequently Asked Questions

By support@poweredbygnosis.com

Q: Which exclusion list should I use to check employees and vendors, the OIG-LEIE or the GSA-SAM? It is recommended that you check both the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) and the General Services Administration’s (GSA) System for Award Management (SAM) databases as well as all of the publicly available State Medicaid Exclusion Lists. According to 42 CFR Part §455.436(b) — Federal database checks, State Medicaid agencies must: Check the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the System forLearn MoreMedicare Exclusion Lists Frequently Asked Questions

HIPAA Administrative Simplification Regulations Overview

By support@poweredbygnosis.com

More than twenty years ago, Congress passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA). One of HIPAA’s five provisions—Administrative Simplification—mandated that the Department of Health and Human Services (HHS) adopt standards to streamline communications between health care providers and health plans. Administrative simplification requirements govern how providers, health plans, and clearinghouses handle electronic and administrative transactions and set privacy and security standards for transmitting health information. This is done by developing and enforcing regulations that adopt standards, operating rules, unique identifiers, and code sets that these types of individuals and organizations, known as HIPAA-covered entities, are requiredLearn MoreHIPAA Administrative Simplification Regulations Overview

Comparing the HIPAA Privacy Rule and Security Rule

By support@poweredbygnosis.com

The Privacy Rule 45 CFR Part 164 Subpart E sets the standards for using and disclosing protected health information (PHI). In contrast, the Security Rule 45 CFR Part 164 Subpart C explicitly sets the Security Standards for the Protection of Electronic Protected Health Information (ePHI). Electronic vs. oral and paper It is important to note that the Privacy Rule applies to all forms of patients’ protected health information, whether electronic, written, or oral. In contrast, the Security Rule covers only protected health information in electronic form (ePHI), including ePHI created, received, maintained, or transmitted electronically. The Security Rule sets theLearn MoreComparing the HIPAA Privacy Rule and Security Rule

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Free HIPAA Knowledge Quiz

By support@poweredbygnosis.com

This HIPAA Knowledge Questionnaire is Free and does not require an Email. You can take it as often as you like. This questionnaire will test your general knowledge of HIPAA laws, containing eighty True/False and Multiple-choice questions covering the Security Rule, Privacy Rule, workplace behavior, cybersecurity, and breach notifications. The correct answer for each question that was answered incorrectly is shown to help you learn the HIPAA laws as you go.

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Free PHI Disclosure Decision Tool

By support@poweredbygnosis.com

This Protected Health Information (PHI) Disclosure Decision Questionnaire is Free and does not require an Email to use. You can use it as often as you like. It follows the decision tool Health and Human Services (HHS) developed and is more user-friendly than clicking through the interactive PDF document. The questionnaire will help you understand how the Privacy Rule applies from the standpoint of the source of the health information. Protected health information (PHI) is any information that can be used to identify a person and is related to their health, including: The HIPAA Privacy Rule provides federal protections for personal healthLearn MoreFree PHI Disclosure Decision Tool

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Free Covered Entity Decision Tool

By support@poweredbygnosis.com

This Covered Entity Decision Questionnaire is Free and does not require an Email to use. You can use it as often as you like. The questionnaire will help you determine whether an organization or individual is a covered entity under the Health Insurance Portability and Accountability Act (HIPAA). The Centers for Medicare & Medicaid Services (CMS) developed a Covered Entity Decision Tool as an interactive PDF document. This questionnaire follows the documented process flow but is more user-friendly. What is a Covered Entity? Individuals and organizations that must comply with HIPAA are called Covered Entities, which include Health Plans, Clearinghouses,Learn MoreFree Covered Entity Decision Tool

Understanding the CMS Open Payments

By support@poweredbygnosis.com

Open Payments, managed by the Centers for Medicare & Medicaid Services (CMS), is a national disclosure program created by the Affordable Care Act (ACA). Open Payments is a federally mandated program that collects and publishes information about payments reporting entities make to covered recipients. The Open Payments database is publicly accessible. The program promotes transparency and accountability by helping consumers understand the financial relationships between pharmaceutical and medical device companies, physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, anesthesiologist assistants, and certified nurse midwives otherwise referred to as Non-Physician Practitioners (NPP), and teaching hospitals. The healthcare providers included in Open PaymentsLearn MoreUnderstanding the CMS Open Payments

How to Apply for an NPI

By support@poweredbygnosis.com

Healthcare providers may apply for an NPI in one of three ways: Option 1 Apply through a web-based application process. Visit the National Plan and Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/NPPES/Welcome.do on the CMS website. Individual providers must create a username and password through the Identity & Access Management (I&A) System and login to NPPES using that username and password. Option 2 Complete, sign, and mail a paper application to the NPI Enumerator address on the form. For a copy of the application (Form CMS-10114, “NPI Application/Update Form”), refer to the https://www.cms.gov/Medicare/CMS-Forms/CMSForms/Downloads/CMS10114.pdf on the CMS website. To request a hardLearn MoreHow to Apply for an NPI