The Office of Inspector General (a division of the U.S. Department of Health and Human Services) has mandated that certain individuals or entities must be excluded from participation in federal healthcare programs. There are several reasons for this exclusion, including a history of program fraud, convictions related to a controlled substance, and healthcare-related crimes. Once an individual or entity appears on this exclusion list, they are not permitted to submit claims or orders to any federal healthcare programs such as Medicaid, Medicare, or TRICARE. To ensure that a healthcare employee (current or potential) does not fall into this category, businesses should use an automated monthly exclusion screening tool. Here are three reasons why an automated monthly exclusion screening tool is useful for your healthcare business.
1) It saves time and increases efficiency.
While it's possible to perform the exclusion screening manually, an automated method will save your team a great deal of time and effort. Checking for exclusions on your own can take unnecessary time, whereas the automated system will do the majority of the work for you in mere moments. Most automated monthly exclusion screening tools work by combining the information from all of the master lists (both federal and state) into a single database and then running the employee data that you provide against potential matches on the list. This allows you to focus your energy on other aspects of your business and improve your efficiency in determining whether or not an employee is prevented from participating in a federal healthcare program.
2) It helps to eliminate human error.
As with all processes, there is always an opportunity for human error when screening an employee against the exclusion list. Transposing even one digit on a Social Security number can return incorrect data. An automated tool removes that possibility by using complex algorithms to recognize exceptions and check for any anomalies that may occur. This helps ensure that the results are more reliable than they would be with a manual screening. You still have the ability to double-check the automated process as well. Once you receive the results of the exclusion screening, you can verify the information if you wish. You should run the report monthly across your entire business to confirm that you haven't missed anything through manual screenings.
3) It ensures full compliance with the law.
Failure to perform the exclusion screening can lead to serious consequences for your business. There are expensive fines and penalties for permitting an excluded individual or entity to participate in a federal healthcare program. If you are unaware that an individual is on the exclusion list, you can still be held liable for violations of the law. For this reason, it's vital to conduct the screening appropriately. An automated monthly exclusion screening tool will quickly give you the information you need so that you can act in a timely fashion to rectify any HR issues and remain in compliance at all times. You'll save thousands of dollars from possible fines, and you'll also be prepared in the event of an audit.
With fast and reliable techniques, automated monthly exclusion screening tools can help you guarantee that your employees are following the legal requirements of submitting any orders or claims to a federal healthcare program.