For this lesson, we will cover the different types of monitor alerts that you may review. The types of alerts will depend on the types of services that your organization has contracted.
For more information on additional level of monitoring services, please reach out to firstname.lastname@example.org or 615-938-7878 ext 1 and we can connect you with the business development team.
Exclusions: There are numerous reasons an individual or entity could be excluded. Federal and state agencies sanction, suspend, exclude or debar individuals and companies from federally funded benefit programs for a variety of reasons, including fraud, drug abuse, issues with licensure, healthcare related misdemeanors or felonies and defaulting on federally backed student loans. Forty-two states, along with the two federal government agencies, maintain exclusion lists that are updated on a regular basis.
If a person or entity is excluded, they cannot receive direct or indirect payment from federal benefit programs. Healthcare organizations cannot make payments to such vendor or person, without incurring a fine or penalty.A complete list of all exclusion sources can be found here. There are two types of Exclusion Alerts for your review in Passport. Matched Exclusion (Red Result Status) and Unable to Determine Exclusion (Yellow Result Status)
MatchedExclusion means that we definitively matched your provider to an exclusion on one of the two federal or 42 state exclusion lists. When we uncover these, we both call and email the designated parties at your organization as these can be time sensitive.
Unable to Determine Exclusion means we have found an exclusion with the same name as your provider, however, we do not have enough information from the exclusion source to provide a definitive match or no match verification result. These are most common with older exclusion records and providers who have common names (think - John Anderson, Marcia Garcia, etc). Our verifiers perform advanced research in efforts to reach a definitive result such as using public records data, NPI information, working with credit bureau partners, address history, etc and have not been able to reach a definitive result with the information available. As we do not believe these can be solved, there is no expectation for you to complete the research where we left off, simply to have a compliance plan in place to address the risk. Common best practice among clients is having the provider sign an affidavit stating they have never been excluded and keeping on record. For more information on an unable to determine exclusion and a copy of a sample affidavit, please visit What is An Unable to Determine Exclusion?