Would you be comfortable sitting in the backseat of an Uber if the person behind the steering wheel had a record of drunk driving and countless accidents? The same thinking applies in the healthcare industry. Providers must ensure that all their employees and contractors are capable of handling their responsibilities with the utmost care and professionalism.
But what does exclusion mean, and how does an organization determine it? Here’s an overview of exclusion database monitoring.
What Is Healthcare Exclusion?
To maintain the principles of the Department of Health and Human Services (HHS) programs, the Office of Inspector General (OIG) has the power to exclude certain individuals and entities from federally funded healthcare programs. This means that designated people aren’t allowed to participate by furnishing, prescribing, or offering services. In turn, excluded entities can’t receive money from federal or state healthcare programs.
People can be excluded because they pose a risk to patient safety and threaten the well-being of healthcare facilities. This includes everything from convictions revolving around the distribution of illegal substances to patient abuse and neglect.
How Do You Know Who Is Excluded?
The people who have been excluded can be found on two federal exclusion databases, as well as numerous state exclusion lists. One of them is the OIG list of excluded individuals/entities (LEIE), which contains people who have been excluded from participating in federal healthcare programs. Another is the System for Award Management (SAM) exclusion list which has records of providers who have been debarred under a federal contract for various reasons. State medicare departments also have exclusion lists, meaning there’s a lot for healthcare organizations to keep track of.
Why Is Healthcare Exclusion Screening Important?
If your facility hires a provider that’s been excluded, they’ll likely receive civil monetary penalties. A fine can be issued for each furnished service, and as you can imagine, the cost can be extraordinarily high. Providers can’t get around the fines by claiming ignorance, as they’ll still be punished even if they were unaware of the exclusion.
Beyond dealing with expensive fines and facing criminal prosecution, the biggest reason why healthcare exclusion screening is so important is patient safety. You would never knowingly put your patients in danger. They’re expecting your facility to have completed the appropriate due diligence to ensure care by the most capable providers.
What Is Exclusion Database Monitoring?
Healthcare facilities must regularly (at least monthly) perform perform OIG exclusion checks and SAM exclusion screening to identify excluded providers. However, as you can expect, this is by no means an easy task. Not only are these lists constantly updating, but having to monitor several different databases on the federal and state levels can be as time-consuming as it is challenging. Some systems, like the Medicaid exclusion list, have different amounts of data that make recording them tricky.
How Can Exclusion Database Monitoring Software Help?
Digital compliance software can provide multiple exclusion monitoring solutions that automate manual parts of the process and remind you to complete tasks. Choose a compliance platform that automates SAM exclusion screening, OIG exclusion checking, and more. Get reporting updates sent to your email directly and automatically to save you time and ensure patient safety.
If you’re searching for exclusion monitoring solutions for your organization, contact MedTrainer today. We offer a variety of healthcare software to help streamline your facility and make it convenient for everyone involved. From compliance program software to healthcare training platforms, there’s something for everyone at MedTrainer. Our software makes exclusion database monitoring easier than ever!