Free HIPAA Knowledge Quiz
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…
Free PHI Disclosure Decision Tool
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…
Free Covered Entity Decision Tool
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…
Provider Termination FAQs
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…
Medicaid Exclusions, Sanctions, Terminations – What’s the Difference?
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…
OIG Self-Disclosure Protocol
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…
How to File a Complaint with Medicare
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…
Exclusion Lists FAQs
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…
HIPAA Administrative Simplification Overview
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…
HIPAA Privacy and Security Rules
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…
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…
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…
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.…
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.…
HIPAA Covered Entity Randomly Selected Review Process
The Centers for Medicare & Medicaid Services (CMS) enforces HIPAA Administrative Simplification Requirements on behalf of the Health and Human Services (HHS). The CMS enforcement activities include proactive enforcement through Compliance Reviews. Here’s what happens when a HIPAA-covered entity is randomly…
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…
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,…
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…