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NPI Number Frequently Asked Questions

By support@poweredbygnosis.com

The Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification required adopting 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

By support@poweredbygnosis.com

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

Suspension and Debarment Frequently Asked Questions

By support@poweredbygnosis.com

How is the DOI Debarment Program organized? The Department of the Interior (DOI) Office of Inspector General (OIG) Administrative Remedies Division (ARD) develops cases. It refers to administrative or non-administrative action recommendations from the Department of the Interior Strategic Data Office (DOI SDO). After the DOI SDO initiates proceedings, ARD staff serves as a case representative. The DOI SDO manages the suspension and debarment program, reviews ARD referrals, issues notices, presides over contested notice proceedings, and issues determinations. Suppose the SDO finds that there is a genuine dispute of material fact. In that case, it may refer the matter forLearn MoreSuspension and Debarment Frequently Asked Questions

The Difference Between the OIG-LEIE, GSA-SAM, and State Exclusion Lists

By support@poweredbygnosis.com

There are two federal exclusion lists: the Health and Human Services (HHS) Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE) and the General Services Administration (GSA) System for Award Management (SAM.gov) Exclusion list, plus 43 State Medicaid/Medicare exclusion lists, but how do they differ, and why do they exist? What is an exclusion, and how does it affect your organization? Exclusions are administrative actions taken against an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or one of the many agencies associated with SAM.gov. Exclusions are levied against employees, vendors, suppliers,Learn MoreThe Difference Between the OIG-LEIE, GSA-SAM, and State Exclusion Lists

Why States Maintain Separate Medicaid Exclusion Lists

By support@poweredbygnosis.com

States must only notify the Health and Human Services (HHS) Office of Inspector General (OIG) 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 would not be posted on the LEIE. Without a separate State sanction list, providers could not determine whether a person or entity had been excluded or terminated. Also, even if the OIG disagrees with a State action based on federal grounds,Learn MoreWhy States Maintain Separate Medicaid Exclusion Lists