How To: Exclusion Check Walkthrough

Conduct monthly OIG, SAM.gov, and state Medicaid exclusion checks to stay compliant and safeguard your practice. Watch the video to learn how!

Referenced links:

Medicare/ OIG
Federal SAMS
Medicaid

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Video on the importance of exclusion checks

Transcript:

We receive a number of calls and questions about, “Okay, I know I’ve got to do these exclusion checks for my employees, but what do I do? How do I go about doing that?” So I just wanted to do a quick walk-through of the three different exclusion checks that you want to do for your employees. And OIG recommends that these are actually done on a monthly basis. So first of all, I’d have you jump over to exclusion.oig.hhs.gov don’t worry about it. I’m going to drop the links right down below, so you’ll have the link to all three of these exclusion checks. But this is the Medicare check. This is the big one that you really want to check, and again, on a regular basis, they recommend that you do that on a monthly basis.

So once you’re on this site, you want to jump over here and simply search for the last name and the first name. In this case, I’m just going to do, you know, a quick search for Smith, and you can see how ultimately these will then pop up. You would find the name of the individual, or hopefully not find the name of the individual that you’re looking for. And once you have you can find out more information and verification of that individual by clicking on the Verify. The next page actually pops up, and I can do that just to protect the people that are listed here, but the next page actually pops up many times, will give you a date of birth, and you can do some additional verification to make sure that it is or it’s at least a close to the same person if they happen to come up. You want to verify because a lot of names are the same. Obviously, I just selected Smith. There are a lot of John Smiths, or whatever the case might be, of course, then just verify that it is actually the right person, you can actually do additional checks, even all the way down to the social security number of the individual to ensure or the NPI of the individual, and that’s the other thing that will come up on the verification page. So typically, when you click on Verify date of birth, and NPI will both come up if the person happens to be on the sanction list. This is very infrequent, especially in the chiropractic world, but it is a worthy check, and you want to make sure that you do that on a very regular basis.

So once you’re done with the OIG side of this, then the other check you want to do is a larger database of government entities. And in this case, we’re going to go to sam.gov and in here we’re going to do a search. So click on the search up in this section here. Go ahead and expand the domains by clicking the plus sign, and you’re going to do entity verification. I won’t do the sign-in information here, and I’m not sure what the requirement is, because we can get everything we need to without that sign-in, go ahead and select exclusions. At that stage, scroll down again and you will see excluded individual. And in this case, go ahead and click it’ll expand out where you can include information on the individual that you’re verifying. Once again, just to demonstrate, I’m going to select Smith. That person will be added to the search. The more information that you provide, of course, the better. And you can narrow it down. In the same way that we talked about on the OIG side of things, on the SAM side, make sure that you do verify that it is the same person. It will provide additional information on when that exclusion started and stopped. This is another important exclusion check.

The last one is from a state-based check for state Medicaid. And again, I’m going to provide all of these links down below. This is just a quick walk-through. In this case, it’s an HFS partner portal, and they have a section for OIG provider sanctions. And so you want to make sure that you don’t have someone who is listed on this particular list. Once you get to this particular page, just go down to the search and once again, search for a last name or provide as much information as you can. You’ll notice that this is listed. It’s listed last name first. So we’ll start again with just Smith, select, enter once you’ve entered that information, and more information will come up about that person, if there is an issue with them and HFS, they will appear here. Once again, you always want to verify that it’s the correct person, and each one of these sites will give you additional information on how to verify if you happen to have someone come up, you want to do these exclusion checks for anybody who is related to either the patient care or the billing specifically related to those areas in your practice. So anybody who again patient care or billing, even appointments you’re getting definitely on the border. There. So if it’s somebody who handles your appointment making and things like that, go ahead and do the exclusion verification, or exclusion checks on on all three of these sites for each one of them, maybe as long as they don’t have access to patient health care information, they’re not doing any billing. If you have janitorial staff or things along those lines, they wouldn’t necessarily have to go through the exclusion process. They’re on a different category because they’re not being dealt with in that billing world. So hopefully this information helps you out. It’s important for you, for your ongoing status with Medicare, Medicaid, and other key areas. These checks are also typically required for many of your PPO contracts, and so you want to make sure that all of these things are taken care of on a regular basis, and we will catch you next week.