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Category: FAQ

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

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

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

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

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