Category: Best Practice

The Medicare Exclusion Database (MED) and You

We are often asked if we have the Medicare Exclusion Database (MED) in our system. We do not collect the MED directly from CMS, but we do have this data in our system. The reason for this is because we collect our data from the primary source, as the Office of Inspector General is the primary source, we do not see a need to collect this data from the CMS as well.

We are precise in our collection. We believe in quality over quantity here at Typhoon Data. We don’t see a need in collecting “Everything”. Instead, we collect the pertinent, actionable, and primary source records that can help you and your clients get a full and complete picture on your health care providers. We take pride in our knowledge of these sources.

Last week, we got official and final confirmation that collecting the MED is not necessary.

Exact verbiage from CMS in regards to the MED:

“The Medicare Exclusion Database (MED) is a national database populated with information from the Office of the Inspector General.”

Typhoon Data is Certified by the NCQA

Typhoon Data, a healthcare data solution provider, announced today it has received certification from the National Committee for Quality Assurance (NCQA), a private, non-profit organization dedicated to improving healthcare quality, for the following credentials verifications services;

License to Practice
DEA Registration
Medical Board Sanctions
Ongoing Monitoring
Medicaid/Medicare Sanctions

This credential verifies Typhoon Data’s use of industry best practices and demonstrates its commitment to quality improvement, increased performance measures, and better compliance data. Typhoon Data was built from the ground up applying knowledge gained from years of industry experience to provide the most effective and accurate solution available. Verification services designed to comply with NCQA credentialing standards demonstrates that Typhoon Data has the systems, process and personnel in place to thoroughly and accurately verify providers’ credentials and help health plan clients meet their accreditation goals.

Recognizing the critical nature of the services they provide, Typhoon Data determined that obtaining certification was a key business strategy. Typhoon Data was built with the customer in mind, and offers integration or turnkey solutions, customization, exclusion data, and verification services. Typhoon Data has revolutionized the method for continuously monitoring compliance data. Typhoon Data is positioned to move the industry forward through innovation and by leveraging technology.

As a bootstrapped startup Typhoon Data has worked to establish sound policies and procedures, and to become an expert in credentialing and compliance. The management and operations teams have created systems that ensure complete, accurate, and timely data gathering and verification. Certification includes rigorous on-site evaluations conducted by a team of health care professionals and certified credentialing specialists. A national oversight committee of physicians analyzes the team’s finding and determines certification based on the CVO’s compliance with NCQA standards.

About Typhoon Data

Typhoon Data is transforming the data industry through automation and partnerships. We make it possible to search for license, exclusion, and board action data in a more efficient and cost effective way. Because our processes are based in the future, we have the ability to offer better products than our competitors at a fraction of the price and in a standardized way that brings new meaning to Compliance Monitoring.

We efficiently handle monthly batching or quarterly reviews, we are constantly monitoring, making it possible for you to truly get the complete picture on your health care staff.

About the National Committee for Quality Assurance (NCQA)

NCQA is a private, non-profit organization dedicated to improving healthcare quality. NCQA accredits and certifies a wide range of healthcare organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Web site (http://www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.

For the original version on PRWeb visit: http://www.prweb.com/releases/2017/01/prweb13989788.htm

It’s a new year…

complianceHappy New Year!!!

Once those words are uttered at 12:01 a.m. on January 1st, we’re all promised improvement. We promise it to ourselves with resolutions and we’re promised it from the people around us. Most resolutions boil down to a single idea: trimming the fat.

Usually, we mean this literally. Whether we’re talking about losing a couple pounds from the holidays, or losing a couple handfuls of pounds. We all want to trim the fat from the previous year. Read More It’s a new year…

Risk: It’s All About Time!

usa-flag-map

Medical Provider data with regards to Medicare and Medicaid exclusions can be tricky from a timing perspective. Even though the Office of Inspector General (OIG) with the List of Excluded Individuals and Entities (LEIE) were created to attack the ever changing problem of Medicare Fraud, it can often be a trailing indicator. There are rules of inclusion that require the OIG to follow a process that often takes time. Once a name or entity is entered into the data set, it is only a matter of checking the names against the dataset either through the government website, downloading the data or using a Consumer Reporting Agency (CRA) or similar service.

The OIG is focused on this issue and does a good job to keep the data up to date as possible and it is a large effort indeed considering the estimate of Medical licensed professions is just under 12 million according to the most recent estimates.

But what about the risk of those organizations that hires or does business with individuals or entities who have been convicted of a crime or state boards who have taken action but the license is unaffected or the OIG has not issued an exclusion? What is the time factor of when the offender or subject shows up on the LEIE list? Or are the various State Medicaid lists timelier? Not all states have Medicaid sanctions lists but the number has grown to 37 states with the recent addition of Iowa and Georgia this year.

Let’s take for example the case of CNA Kenisha Abeene. Her name showed up on the Nevada List of Sanctioned Excluded Providers in early 2014. Her name did not appear on OIG until January of the following year.

As a matter of process, TyphoonDATA pulls press releases from various Law Enforcement sites, both state and federal to gauge how fast the issues get across the spectrum of reporting entities which include Federal sources like OIG, DEA Disbarment, SAM.gov and state exclusion sites like https://dch.georgia.gov/georgia-oig-exclusions-list. Also the issues might initially surface in Licensing repositories like Department of Professional Licensing or DOPL (pronounced “Dop-Pull”) or specific board sites. Unfortunately, the states are not uniform in the approach to posting and size does matter with regards to provider type licenses. There are more Doctors and Nurses in this country so often those boards have daily updates.

For example, in the case of Physician Cyrus Sajadi, Dr. Sajadi was charged in 2012 and his name was all over the DOJ and other news sites. But, there was no action granted until 2015. Meaning his license stayed clear and without action for three years, making it possible for him to practice when he was known to have committed fraud. Leaving any organization that hadn’t known of his fraud opens them up to potential risk. For three years, his name did not pop up on the OIG or any state exclusion site. Knowing as much about your employees or potential employees as possible will cut away at your exposure to fraud or potential fines.

Moving from state to state also presents challenges. Doing a Social Security (SSN) trace often reveals multiple states the subject has lived, worked or studied. Name changes, especially in marital status, are also a driving issue. The exclusion is a post that is current at the time of posting and personal identifying information or Pii is needed to capture the action or exclusion. Often the board action is “thin file” or lacking identifiers so Sherlock Holmes will be needed to crack the case.

And last but not least this is not a one and done issue. Continuous monitoring not periodic batching is recommended. The on-going update process of data should be at a minimum monthly and some sites (Medi–CAL) have some provider types where daily updates are done.

Here are examples of delayed reporting:

INDIVIDUAL

PROVIDER TYPE

DATE OF BOARD ACTION

DATE OF APPEARANCE IN THE OIG LEIE

H, AMBER DAWN

Pharmacy Technician

10/25/2013

1/20/2015

B, BENJAMIN

CNA

12/22/2014

5/20/2015

P, THOMAS A

Pharmacy Technician

11/22/2013

1/20/2015

A, DAVID

LPN

5/15/2006

8/20/2006

A, KENISHA

CNA

3/27/2014

1/20/2015

 

Slipping Through the Cracks in the Process

More and more public watchdog groups, press and user groups are finding holes in the system that may be of concern to those who are hiring or credentialing medical providers.  The article dated June 30, 2014 from NPR demonstrates the complexities and timing issues.  Some providers are able to circumvent the billing process and continue to receive payment for years after being acted upon by the various state medical boards. http://www.npr.org/blogs/health/2014/06/20/323889329/sanctions-common-against-doctors-with-odd-medicare-billing?ft=1&f=1001

Credit Reporting Agencies focusing on hiring, compliance groups and credentialing organizations have the mission to surface issues beyond just the exclusion data repositories like the Office of the Inspector General (OIG) or one of the many Federal sites that track violators.  As you know, being excluded from the Federal Medicare process is only one element of the wider net that is needed to get all the data to make a hiring, risk or just plain due diligence decision.

The problem is often just timing.  A scenario might be a provider is arrested for a crime and adjudication begins.  Maybe a state medical board reviews the incident and takes action.  The various states may jump into action and exclude the provider from receiving Medicaid payments which is administered from the states even though the money comes primarily from the Federal tax dollars.  The license may be affected at the board level and it make take time to get into the exclusion process.  Hearings have to be set and conclusions reviewed.

It is the due process that takes time and we all appreciate the need for it.  But if you are a hiring entity or compliance group you may get caught in the cracks.  The key is to check the various Federal, State and board actions that will blanket the whole process.

It is possible to get an accurate, up to date picture and TyphoonDATA has a solution with will cast a wide net, verify the false positives and close the cracks into a simple to use click process.

If you would like to discuss, call us at 800.780.5901 or email us at RRupert@typhoondata.com or SSkyhawk@typhoondata.com .  We would love to help you with your mission.

 

Lean Thinking and the Art of Creating Value in the Screening Industry

By Kim M. Kerr, CEO, TyphoonDATA

I am a firm believer and activist for Lean Thinking in any business I have worked in since the day I heard of the simple, commonsense approach to the workplace improvement process.  This includes the Screening and Data businesses.  Finding or creating a value stream for customers or clients has become a passion for me.  I had the opportunity to work with some great companies in the data and screening world that have embraced this approach to management and have seen dramatic improvements in the work environment, culture, and top and bottom lines of businesses of all shapes and sizes.  This process is an integral part of the culture at my current company.

I came from an investigative and event security background working for AT&T for many years performing internal investigations, event security including the 1996 Summer Olympic Games, leaving in 1998 after another “reengineering” that resulted in 15,000 managers getting the option for a benefit and retirement “buy out”.  I had seen literally years of downsizings and reengineering projects while managers struggled to catch a falling knife.  I watched thousands of workers either get laid off or reorganized into other jobs or departments in an attempt to find a level that could be supported by the customers.

What finally happened a few years after my departure was a series of mergers, sell offs and eventually a sale of AT&T to one of the Regional Telco’s.  The AT&T trademark, a brand known round the world, was garnered by this new business that is now a strong player in the cellular and business communications market.  It survived by being cut to ribbons over time.  The old AT&T died a death of a thousand cuts.

I have two family members who work in the manufacturing industry.  One is an Operations Manager for a packaging company; the other is an HR Manager for a bedding firm.  I was the Vice President and General Manager for LexisNexis Screening Solutions at the time and as I listen to those two use strange Japanese terms like “Gemba”, “Kaizen” and “Muda”, I began to wonder if Lean Principles would work in the screening and data business.  After some research I started putting this process in front of my Directors.  The results were incredible and the Principles of Lean are now an integral part of the DNA of any company I lead.

The topic is much too big to be covered in an overview article but I can give you some valuable concepts to think about.  First of all I used the term “big” not complicated.  Understanding the value your customer needs and wants from your products and services needs to be understood, articulated and embraced by all of your employees from the CEO to the rank and file.  This is defined as the “Value Stream”, a river of value that flows to your customers.

Along the stream is Muda or waste.  As an example, I was at a client location and saw employees standing around the copier.  They were creating copies of information to be used in the daily work.  I then noticed that all the work stations had two screens but the line was forming from a subset of the workers.  I asked my client what they did and he responded that they were involved in a value stream that fed into the screening report for several key clients.  It was a process outside the normal workflow.

I exclaimed, “Muda” to my client pointing at the copier clutch.  We looked at the wasted time of these employees standing by a copier.  The employees used that as a high tech water cooler to discuss last night’s game and where they were going after work.  So by just walking around the workplace or “Gemba” a trained observer saw a process improvement or “Kaizen” opportunity that had been gradually embraced as “just part of the process”.

The ultimate solutions was to review these processes in detail and the solutions which required a queuing change in the operations software and installing a third screen at two workstations, reassignment of two employees to other pressing processes.  In other words the value was doubled and waste was halved.

So here is my simple recommendation:  Buy a couple of books, Lean Thinking: Banish Waste and Create Wealth in Your Corporation by Womack, James P. and Jones, Daniel T. (Nov 23, 2010); and Gemba Kaizen: A Commonsense Approach to a Continuous Improvement Strategy 2/E by Masaaki Imai (May 23, 2012).  These books have a good framework for instituting Lean thinking into your business.

Have a meeting with your directors or lead managers and follow a few simple steps:

1)      Walk around the Workplace or “Gemba” and observe your employees.  Look at things like the workstation set up, which teams interact with which teams, use of ancillary devices like copiers or email processes.

2)      Ask your key managers what are the top three problems they spend most of their time on during the day?  Ask all the leaders to describe the issue.

3)      Pick one based on the biggest impact to one of the work groups.

4)      Break it into steps or Kaizen the process.  If need be, bring a “doer” into the discussion.

5)      Develop a theory of how the process could be changed and how the process can be measured.  If it can’t be measured, how can you know if you are successful?

6)      What is the investment in the change? – Development time, Project Management, outside resources.

7)      Make the changes.  Measure your success.

8)      Wash, rinse, repeat…

I also recommend instituting an accountability board in all your operations managers’ offices.  What is due in the next 24 hours?  Who is responsible and what is the deliverable?  I call this, “Moving the Ball”.

If you have a process you like, great!  But if you can’t seem to get your margins to grow or you are continually adding people during the good times and laying off others in the slow times, you may be a victim of the reengineering mind game.  Lean Thinking is anything but that.

There are companies or organizations Lean Thinking will NOT work.  It is in companies where the top leadership believes that all real good ideas and processes emanate from the top.  The Lean ship will sink on the sharp rocks of EGO surrounding the crystal tower of pure thought and reason.

Kim can be reached at KKerr@typhoondata.com

 

Why should you check the STATE data as well as the FEDERAL sources!

Recently Bloomberg Businessweek published an article entitled, Why Medicare Keeps Paying Sketchy DoctorsBy John Tozzi, David Armstrong and Caroline Chen. (May 1, 2014). In this article the authors discuss the sometimes loose data pass from the States to the Federal regulators data sets. Tozzi specifically references Gary Ordog, a California Doctor who is on the California Department of Health Care Services Medi-Cal, Suspended and Ineligible Provider List but not currently listed in the List of Excluded Individuals and Entities published by the U.S. Department of Health & Human Services. A quick search of TyphoonDATA’s Standard Product returns a result for Dr. Ordog, meaning that this is an individual that may require additional research before you hire, contract or privilege.

Since my entry into this area of screening, I made the incorrect assumption that the data that originated at the various state levels transitioned into the various Federal repositories like HHS Office of Inspector General (OIG) and became a part of the LEIE listings. Although improved, they are not quite there as the article points out.

For those of you in the traditional Screening business, this is similar to county criminal data that moves to a state repository. There is sometimes a delay or it doesn’t quite make the pass.

In screening those individuals in the hiring motion or compliance motion, organizations are still using sometimes overlapping sources to make sure a problem is not invited through the door. So checking all the various sources is a business imperative especially with the new mandates under the Affordable Care Act (ACA) better known as Obamacare.

Although Exclusions are only published in the Private Sector in only 32 States (and growing!), the need to ensure your search effectiveness your provider needs to be aggressively layering the data sources and identity mapping. The data might be there, but the searching algorithms may be less than optimal.

TyphoonDATA has a solution we call our “STANDARD” product that would mitigate this happening at your organization. Give it a look!

If you would like to discuss our thoughts and solutions, give us a call at 800-780-5901 or contact me at kkerr@typhoondata.com.