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Provider Termination FAQs

By support@poweredbygnosis.com

Sanctions, Exclusions, Terminations, Suspensions, and Debarment are administrative actions taken against an individual or entity by the Office of Inspector General (OIG), State Healthcare Program Agencies, the Medicaid Fraud Control Unit (MFCU), or one of the many agencies associated with the General Services Administration (GSA), for reasons that include fraud, integrity, or quality. For healthcare organizations, an individual or entity that is sanctioned or excluded by the OIG, terminated by a State Healthcare Program authority, or suspended or debarred by the GSA is prevented from participating in any Federal Healthcare Reimbursement Program, including Medicaid, CHIP, and Medicare programs, regardless ofLearn MoreProvider Termination FAQs

Medicaid Exclusions, Sanctions, Terminations – What’s the Difference?

By support@poweredbygnosis.com

The differences between sanctions, exclusions, and termination are crucial for healthcare organizations to understand when hiring and retaining skilled professionals. Sanctions A sanction results from an administrative hearing where an individual or entity violates an administrative rule, civil law, or criminal offense, leading to various penalties. Sanctions are enforced by the Office of the Inspector General (OIG) or a State Medicaid program authority. A sanction from a healthcare disciplinary or licensing board can lead to significant consequences, the most severe of which is an exclusion. Exclusions An exclusion results from an extreme sanction issued by the Office of Inspector General (OIG). Exclusions areLearn MoreMedicaid Exclusions, Sanctions, Terminations – What’s the Difference?

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 with 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 aLearn MoreHow to File a Complaint with Medicare

Exclusion Lists FAQs

By support@poweredbygnosis.com

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 Exclusion Lists. According to 42 CFR Part §455.436(b) — Federal database checks, State Medicaid agencies must: (b) 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 for AwardLearn MoreExclusion Lists FAQs

HIPAA Administrative Simplification 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 Overview

HIPAA Privacy and Security Rules

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 MoreHIPAA Privacy and Security Rules

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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