It’s overwhelming to check multiple exclusion databases for every provider every month. But, conducting continuous OIG exclusion checks is one of the most important precautions a healthcare organization can take to protect its reputation and revenue. So how do you balance the need for OIG exclusion checks with the time required?

Using automated exclusion list software.

Automating this process can significantly reduce the risk of compliance violations and improve operational efficiency. In this post, I will explore the importance of OIG exclusion checks, the challenges of doing them manually, and how automation can simplify the entire credentialing workflow.

An exclusion list (the primary exclusion list for healthcare industries) contains individuals or entities that are excluded from practicing healthcare and receiving federal healthcare payments due to criminal behavior or misconduct.

The Importance of OIG Exclusion Checks in Healthcare Credentialing

OIG exclusion checks are a fundamental part of the credentialing process in healthcare organizations. The Office of Inspector General (OIG)’s List of Excluded Individuals/Entities (LEIE) flags professionals who should be excluded from government reimbursement programs for criminal behavior, fraud, or misconduct. The list is regularly updated, and it is each organization’s responsibility to ensure they do not have excluded providers billing for services.

If a healthcare organization employs an excluded professional, it can lead to severe consequences including fines, penalties, and the requirement to repay any improperly received funds. This puts the organization’s finances at risk and compromises patient safety and organizational integrity.

Performing regular OIG exclusion checks keeps you on top of every employee and vendor’s status so excluded individuals are not seeing patients. This proactive approach helps mitigate legal and financial risks, protecting both the organization and its patients.

Challenges of Manual Exclusions Monitoring

Clearly conducting OIG exclusion checks is critical, but when you’re doing it manually, it’s error-prone and tedious. 

Healthcare organizations typically need to check multiple exclusion lists — such as OIG, SAM (System for Award Management), and state Medicaid exclusions — for every person on staff, every month (according to NCQA guidelines). Each list requires separate searches and verification, as well as documentation of results for audit purposes. 

Since you likely face interruptions, it can take a full day to find, verify, and track 20 employees. If you have 100 employees, that’s suddenly an entire week of work! These interruptions also make mistakes more likely. It’s easy to skip someone or enter the wrong information into your spreadsheet. 

If you hire an excluded provider, you’ll be punished even if you are unaware of the exclusion. 

Missed or incorrect OIG exclusion checks can also result in compliance breaches, potential audits, and the financial and reputational damage that comes with these violations. As the healthcare industry becomes more complex, manual exclusion checks become outdated, and the risk of non-compliance increases.

How Automation Transforms OIG Exclusion Checks

Automation is a major advancement when it comes to OIG exclusion checks. Automated systems streamline the entire process, eliminating manual searches, data entry, and tedious tracking. Selected databases are automatically checked on an NCQA-approved schedule with the results logged and notifications when an employee’s status changes. 

When exclusion checks are part of healthcare credentialing software, they’re integrated directly into the workflow, ensuring a faster, more accurate process.

Automated exclusions monitoring offers several benefits over manual checks:

Real-Time Updates 

Get notifications when an employee’s exclusion status changes so you can immediately investigate. 

Bulk Processing 

Instead of completing exclusions screening one by one, automation processes all individuals and entities at once, saving valuable time and resources.

Tracking and Reporting 

Automated systems track every exclusion check for every individual and entity, so you can easily demonstrate compliance. Easily customize and save a report that shows all the information an auditor will need.

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Benefits of Automated OIG Exclusion Checks

Implementing automated OIG exclusion checks offers a host of benefits that can improve both healthcare compliance and operational efficiency. Here are some of the key advantages:

Time and Resource Savings

Automated OIG exclusion checks dramatically cut down on the staff time needed for this manual task. It allows employees to focus on higher priorities that drive revenue, such as preparing credentialing packets and enrolling providers. 

Always Compliant

Automated systems continuously monitor exclusion lists so organizations have the most up-to-date information. This helps avoid costly healthcare compliance violations and the risks associated with hiring excluded professionals.

Increased Efficiency

Automation speeds up the healthcare credentialing process, leading to faster new hire onboarding and fewer delays. With bulk processing and real-time updates, organizations can manage exclusions efficiently, ensuring that they maintain compliance without sacrificing productivity.

Simple Reporting

Automated systems typically include robust reporting features that track exclusion status changes, generate audit-ready reports, and flag potential issues. Easily sort and filter reports by individual, location, last exclusion check date, and more.

Implementing Automation for OIG Exclusion Lists in Your Organization

Once you consider your current processes and find the right solution, adopting automation for OIG exclusion checks should be seamless and will allow your organization to jump right in and learn quickly. Here are some steps to implement automation in your organization:

Evaluate Your Current Processes 

Assess your existing exclusions monitoring workflow to determine how long it takes each month. Equate that time to dollars — how much does your current process cost in staff time? Then compare it with the cost of software. 

Be sure to take into account errors or mistakes in your current process that have been costly for the organization.

Choose the Right Software 

Look for solutions that work well with your healthcare credentialing software and process. Many organizations opt for a comprehensive credentialing solution that includes automated exclusion checks, credentialing workflows, automated license verification, enrollment tracking, customizable reporting, and more. 

At a minimum ensure your chosen solution tracks every OIG exclusion list check, with real-time reporting for audit purposes.

Train Your Staff 

Once you’ve chosen the right solution, train your team on how to use it effectively. Establishing clear protocols for using the software and monitoring for updates is essential to ensure smooth implementation.

Monitor and Optimize 

After automation is in place, continuously monitor the process and make adjustments as needed. This includes reviewing reports, tracking compliance, and ensuring that OIG exclusion checks are up-to-date.

Simplify Exclusions Monitoring With MedTrainer

Automating OIG exclusion checks is a powerful way to streamline credentialing processes, improve compliance, and protect your organization from potential legal and financial risks. 

If you’re looking to ditch the old-school workflows and stay ahead of compliance challenges, you need MedTrainer’s automated exclusion monitoring. 

Automation protects your organization and enhances operational efficiency, helping you focus on what truly matters — providing safe, high-quality care to your patients.

Ready to streamline your credentialing process with automated OIG exclusion checks? Learn more today!