According to the Centers for Medicare and Medicaid Services (CMS), all healthcare providers and organizations must obtain a National Provider Identifier (NPI) to avoid having to utilize several identification numbers when dealing with different health plans.
NPI numbers are often used to confirm and verify a wide range of authentication, individual claims, contracts or agreements, and much more because they are free and easy to obtain.
Furthermore, it is necessary to conduct complete monitoring of referring providers and physicians to comply with CMS payment eligibility and avoid the danger of HHS OIG fines and penalties.
Because monthly exclusion checks might be difficult for healthcare organizations owing to a lack of information, NPI numbers can be a valuable asset in this process. When screening and monitoring for excluded parties, as well as referring providers and physicians, NPI records give important information that results in complete transparency.
Exclusions Monitoring for Provider Referrals
Because an NPI registration details is a standardized identification tool for healthcare providers and health insurers, it may be extremely useful in detecting bogus claims and healthcare fraud, as well as in the exclusion screening process.
The List of Excluded Individuals and Entities is the primary source for reference federal healthcare exclusions (LEIE). Healthcare providers and suppliers must verify the LEIE before employing or contracting any employee or contractor to confirm that no workers or referring providers are on the list.
The only way to find sanctioned organizations or individuals is to use their names, although this can lead to a multitude of inconsistencies or errors.
The screening method has become significantly more accurate after the OIG began upgrading federal and state databases to include NPI numbers. Using unique identifiers like NPI numbers reduces the risk of errors and data gaps.
Without diligent investigation of regulatory requirements and exclusion lists, healthcare organizations might easily face compliance challenges.
Obtaining all available information on excluded and sanctioned healthcare workers, vendors, volunteers, referrals, business associates, and more requires using the NPI number in conjunction with screening against LEIE, SAM, and state Medicaid listings.
Exclusion screening systems can save healthcare organizations time and reduce the risk of non-compliance by automating this procedure, which can be complex and time-consuming.
Continuous monitoring of the complete provider network across both federal and state exclusions lists, as well as validating NPI numbers against the NPPES NPI Registry, is made easier with this technique. As a result, healthcare organizations can meet all regulatory standards while also reducing fraud and improving compliance.