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Category: Medicare

Termination of Provider Participation FAQs

By support@poweredbygnosis.com

Section 6501 of the Affordable Care Act requires each State Medicaid program to terminate any provider who has been terminated under Medicare or by another State Medicaid program. The Centers for Medicare & Medicaid Services (CMS) has defined “termination” as occurring when a State Medicaid program, CHIP, or the Medicare program has taken action to revoke a Medicaid or CHIP provider’s or Medicare provider or supplier’s billing privileges and the provider, supplier, or eligible professional has exhausted all applicable appeal rights or the timeline for appeal has expired. The requirement to terminate only applies in cases where providers, suppliers, orLearn MoreTermination of Provider Participation FAQs

Exclusion, Sanction, and Termination, what’s the difference?

By support@poweredbygnosis.com

The differences between exclusion, sanction, and termination are crucial for healthcare employers to understand when seeking to find and retain skilled professionals. Because the HHS-OIG and GSA-SAM federal databases refer to exclusions as “sanctions,” healthcare and compliance professionals often confuse the two terms because they are incorrectly used interchangeably. 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) in the U.S. Department of Health and Human Services or a state Medicaid program. A sanction from aLearn MoreExclusion, Sanction, and Termination, what’s the difference?

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