Here at Typhoon Data we’ve been getting into the holiday season by celebrating over a three day period, as we couldn’t contain our excitement for the holidays to just one day. On Thursday we had the opportunity to decorate stockings as a company. The stockings turned out great (with exception to my own) and the conversation was even better.
The festivities picked up again the following day by starting with lunch at Tucanos, which allowed us to celebrate the hard work we had put in this year and provide the opportunity to socialize with our coworkers. When lunch drew to a close we were given gifts that were generous and delicious. After all this we were addressed by Questin Francis (Our CEO) to thank us and congratulate the company on the hard work we had been doing all year.
After our lunch we were fortunate to spend a few hours decorating cookies, doing crafts and helping facilitate a Christmas party at Provo Rehabilitation and Nursing for some of the patients that are currently staying there. It was a nice way to spend the rest of the afternoon and celebrate the holidays by getting to know people and help them celebrate their holidays too.
The next Wednesday we had the opportunity to create gingerbread houses as part of the festivities and to get to know those we don’t frequently work with. The end results were creative and unique, one of our employees came up with a lengthy backstory to why their gingerbread spaceship (they took liberties with the resources they were given) should win. All in all, it was a fun activity for all those involved.
The Preclusion List is a list of prescribers and individuals or entities who fall within any of
the following categories:
(1) Are currently revoked from Medicare, are under an active reenrollment bar, and CMS has determined that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program; or
(2) Have engaged in behavior for which CMS could have revoked the prescriber, individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare program. Such conduct includes, but are not limited to, felony convictions and Office of Inspector General (OIG) exclusions.
Why was it created?
The CMS-4182 Final Rule was created to make revisions to the Medicare Advantage (MA) program (Part C) and Prescription Drug Benefit Program (Part D) regulations based on our continued experience in the administration of the Part C and Part D programs and to implement certain provisions of the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act.
Will I get access to it?
Did you have access to the Medicare Advantage (MA) program (Part C) and/or Prescription Drug Benefit Program (Part D) in the past? If so, then you can get access to this list by applying to receive access to the EDMI through CMS. Submit your application here.
Who is required to search the CMS Preclusion List?
Preclusion List Requirements for Prescribers in Part D and Individuals and Entities in MA, Cost Plans, and PACE
This final rule will rescind current regulatory provisions that require prescribers of Part D drugs and providers of MA services and items to enroll in Medicare in order for the Part D drug or MA service or item to be covered. As a replacement, a Part D plan sponsor will be required to reject, or require its pharmacy benefit manager to reject, a pharmacy claim for a Part D drug if the individual who prescribed the drug is included on the ‘‘preclusion list.’’ Similarly, an MA service or item will not be covered if the provider that furnished the service or item is on the preclusion list. The preclusion list will consist of certain individuals and entities that are currently revoked from the Medicare program under 42 CFR 424.535 and are under an active reenrollment bar, or have engaged in behavior for which CMS could have revoked the individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that led, or would have led, to the revocation is detrimental to the best interests of the Medicare program. We believe that this change from an enrollment requirement to a preclusion list requirement will reduce the burden on Part D prescribers and MA providers without compromising our program integrity efforts.
The CMS preclusion list is not for background screening. It’s available to Part C and Part D prescribers. Its primary purpose is to eliminate the opioid epidemic. The creation of this new list is in response to the Comprehensive Addiction and Recovery Act of 2016 (CARA). There may be excluded providers on this list, however, those exclusions will also still be listed on the OIG.