What Is Exclusions Screening and Why Is It Important?

Sarah Jones

Would you be comfortable sitting in the backseat of an Uber if the person behind the wheel had a record of drunk driving and countless accidents? Probably not! The same thinking applies in the healthcare industry. There are ramifications to malpractice, and it’s the goal of exclusion screening to make sure physicians and other practitioners are capable of handling their responsibilities with the utmost care and professionalism.

But what, exactly, is exclusions screening and how does an organization approach it? Let’s take a look at exclusion database monitoring, how it works, and why it’s so important.

What Are Healthcare Exclusions?

To align with the principles set by 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.

In a nutshell, healthcare exclusions function sort of like a no-fly list. If you’re excluded, you won’t be able to practice medicine or administer healthcare to patients.

Generally, people are excluded because they pose a risk to patient safety or threaten the well-being of healthcare facilities. This includes everything from convictions revolving around the distribution of illegal substances to patient abuse and neglect. No one ends up in the exclusion database by accident — it takes serious charges to land there.


WEBINAR: How To Speed Up Your Enrollment Process

Why Is Healthcare Exclusions Screening Important?

If your facility hires a provider that’s excluded, you’ll likely receive civil monetary penalties. A fine can be issued for each service that individual provides — and as you can imagine, the cost can be extraordinarily high. Providers can’t get around the fines by claiming ignorance, either. You’ll be punished even if you were unaware of the exclusion, which makes it all the more important to check before hiring.

Beyond dealing with expensive fines and facing potential prosecution, the biggest reason healthcare exclusion screening is so important is for 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. That means checking exclusion databases.

How Do You Know Who’s Excluded?

Exclusions screening needs to be done when a provider is hired — along with all other credentialing checks and documentation — as well as consistently after that. To check the status of new hires and current staff, organizations need to consult two federal exclusions databases, as well as numerous state exclusions lists.

While it seems simple on paper, navigating these exclusions databases can be cumbersome and time-consuming. It’s a manual process — and a tedious one, at that! These lists update frequently and some systems (like the Medicaid exclusion list) have complex data that make navigating them tricky.

Many healthcare organizations only check exclusions databases a few times a year or annually, because it requires them to check provider after provider to ensure they’re not listed. Unfortunately, this isn’t often enough. Organizations need consistent exclusion database monitoring.

The Benefits of Exclusions Database Monitoring Software

Healthcare facilities need to regularly perform OIG exclusions checks and SAM exclusion screening to identify excluded providers. Undertaking this process manually just isn’t an option — organizations would need to hire someone full-time to constantly check and re-check provider statuses! It’s just not practical. Automated exclusions database monitoring, however, is.

Exclusions database monitoring involves using digital compliance software that automates the tedious, manual parts of the process — and can remind you to complete clerical tasks related to exclusion checks. For example, the ability to instantly check SAM exclusions and OIG exclusions can save hours at a time!

It takes only seconds for software to verify that a provider is or isn’t on the exclusions list. If they aren’t, it can generate verification that your providers are all-good to continue working. If they are on the list, it can flag that individual and recommend further action. Ultimately, the automation aspect of exclusions database monitoring software makes it easy to focus time and energy on what matters most: ensuring patients get the highest caliber of care.

Can Providers Get Off the Exclusions List?

What happens if your database search turns up the name of one of your providers? Do you need to fire them? Suspend them? Report them? More importantly: how do they get off of the exclusion list?

The OIG has a reinstatement process in place for excluded providers to resume participation in federal healthcare programs. Reinstatement isn’t automatic: it requires the individual or entity to apply for reinstatement and receive written notice of reinstatement from the OIG. Typically, exclusions last a minimum of five years, and providers can initiate the reinstatement process up to 90 days before the end of their exclusion period.

Simplify Exclusions Screening Practices

Exclusions screening and database monitoring are a core part of compliance management at any healthcare facility. That means they’re also part of MedTrainer.

MedTrainer makes it easy to automate database screening and generate exclusion reports that are sorted and color-coded to see provider status and changes. Plus, you can even set up notifications for when providers change status. What used to take hours now takes seconds, with the data and information you need for peace of mind about your next hire and your current staff of providers.