exclusion screening

What is the CMS Preclusion List? What is the Difference Between an Exclusion and a Preclusion Action? How Can You Appeal a CMS Preclusion Action?

Medicare, Medicaid & Private Payor Updates /

(October 8, 2019): On April 16th, 2018, the Department of Health & Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), issued a Final Rule entitled, “Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program.” […]

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Exclusion Screening-OIG Screening: The New “Seventh Element” of Compliance.

Compliance, Medicare, Medicaid & Private Payor Updates /

(May 17, 2017): Exclusion screening-OIG screening duties are now more important than ever before! The recently issued Resource Guide for Measuring Compliance Program Effectiveness” a product of Office of Inspector General staff and compliance professionals roundtable discussions, reconfigures the traditional “Seven Elements of an Effective Compliance Program” by making the “Screening and Evaluation of Employees, Physicians,

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Exclusion Screening / OIG Screening and Background Checks in Dental Practices

Dental Audits & Compliance /

(March 31, 2016): Many of the dental practices around the country do not participate in the Medicaid program and only a small number of dental practices provide services that might qualify for coverage under Medicare.  Notably, the fact that most dental practices only accept cash or a handful of private payor plans significantly reduces their

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Exclusion Screening Enforcement Actions by OIG are Increasing.

Medicare, Medicaid & Private Payor Updates /

(December 8, 2015): Since the passage of the Patient Protection and Affordable Care Act of March 2010[1] (ACA) and progeny such as the HITECH Act [2], enforcement efforts have been better funded and consequently, better staffed. The enactment of HIPAA in 1996 [3] and the Balanced Budget Act (BBA) of 1997 [4], further expanded the

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Medicaid Dental Audits: Exclusion Screening Issues

Dental Audits & Compliance /

(January 22, 2015): Medicaid dental audits have greatly expanded over the past few years. As many (if not all) dentists and orthodontists are painfully aware, the both federal and state law enforcement agencies have doggedly pursued Medicaid dental providers in their efforts to recoup funds paid to dentists and orthodontists for the provision of medically

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There are Seven Compliance Plan Elements – Is Your Healthcare Company Compliant?

Dental Audits & Compliance /

(August 2, 2012): Under the Affordable Care Act (ACA), which was recently upheld by the Supreme Court, the Secretary of the Department of Health and Human Services (currently Kathleen Sebelius) may require that all providers participating in federal health care programs implement an effective compliance plan. While regulations covering this issue have not yet been

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