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Understanding the CMS Open Payments

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 that 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 OpenLearn MoreUnderstanding the CMS Open Payments

How to Apply for an NPI

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

NPI Number Frequently Asked Questions

The Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification required the adoption of a standard for a unique health identifier for healthcare providers. The NPI Final Rule, published on January 23, 2004, established the NPI unique identification number as this standard. Covered healthcare providers, health plans, and clearinghouses must use NPIs in administrative and financial transactions. The Centers for Medicare & Medicaid Services (CMS) developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. For more information on how to apply for an NPI, visit https://nppes.cms.hhs.gov/NPPES/Welcome.do. What Is an NPI? A National Provider Identifier (NPI) is aLearn MoreNPI Number Frequently Asked Questions

How to File a HIPAA Complaint

The Centers for Medicare & Medicaid Services (CMS) enforces HIPAA Administrative Simplification Requirements on behalf of Health and Human Services (HHS). The CMS enforcement activities include investigating complaints about potential noncompliance. Anyone can file a complaint against a HIPAA-covered entity. Overview of ASETT The Administrative Simplification Enforcement and Testing Tool (ASETT) is a free online tool operated by the CMS National Standards Group (NSG). One of the tool’s key capabilities is allowing users to file a complaint alleging that a HIPAA-covered entity, directly or through a business associate acting on its behalf, is noncompliant with Administrative Simplification requirements related toLearn MoreHow to File a HIPAA Complaint

SAM Suspension and Debarment FAQs

What are Suspension and Debarment? Suspensions and debarments are “administrative remedies” used to prevent the Government from working with parties who are not “presently responsible”. An individual or entity is not presently responsible if they engaged in criminal activity or other improper conduct, or have demonstrated serious poor performance to such a severe and compelling nature that it would lead to questioning their honesty, ethics, or competence. Federal agencies use these remedies to exclude parties from obtaining new Federal contracts, certain subcontracts (procurement), discretionary assistance, certain funded lower-tiered transactions, leases, loans, loan guarantees, and other benefits (non-procurement). Both suspended andLearn MoreSAM Suspension and Debarment FAQs

OIG, SAM, and State Exclusion Lists – What’s the Difference

You know it’s essential to screen new hires, current employees, and vendors against the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE), the General Services Administration (GSA) System for Award Management (SAM), and all available State Exclusion lists, but what’s the difference? HealthProviders DB is an unparalleled solution that allows users to effortlessly and simultaneously search OIG Exclusions, SAM Exclusions, State Exclusion Lists, FDA Debarment, and Clinical Investigators—Disqualification Proceedings—all in one powerful platform! The OIG List of Excluded Individuals and Entities (LEIE) The Office of Inspector General (OIG) maintains the List of Excluded Individuals/Entities (LEIE) that is updatedLearn MoreOIG, SAM, and State Exclusion Lists – What’s the Difference

State Exclusion List FAQs

Why do States have an Exclusion List? States are required to notify the Health and Human Services (HHS) Office of Inspector General (OIG) only when they exclude or terminate an individual or entity based on federal law. States are not required to notify the OIG (nor should they) of actions based on state laws because if the sanction fails to meet the criteria for a federal exclusion, the exclusion will not be posted on the LEIE. It can take several months for the OIG to process the State-reported sanction and determine if the OIG will also impose a federal exclusion based onLearn MoreState Exclusion List FAQs