Category: Primary Source

Reviewing Sanctions – What does the word “sanction” really mean?

sanc·tion
ˈsaNG(k)SH(ə)n/
noun
a threatened penalty for disobeying a law or rule.
“a range of sanctions aimed at deterring insider abuse”

Sanction is a term that is often used when referring to databases like ours. I’m often asked “do you have a sanction database?” or “is this a sanction check?”

We do have sanctions in our dataset. For example, Office of Foreign Assets Control (OFAC) has many lists of sanctioned individuals.

However, it’s a common misconception that an entire dataset like ours is a Sanction Database or Sanction search. Sanctions usually refer to Financial Sanctions. Financial Sanctions are restrictive measures imposed on individuals or entities in an effort to curtail their activities and to exert pressure and influence on them.

Our focus at Typhoon Data is to assemble a data set of all Federal and State Exclusions and Board Disciplinary Actions. Many organizations publish critical information for our customers, and we gather all of it, including Opt out affidavits, abuse registries, and imposter lists.

Federal and State Exclusions are Individuals and Entities that are excluded from participation in Medicare, Medicaid and other federal and state healthcare programs.

Termination occurs when the Medicare program, a State Medicaid program, or CHIP has taken an action to revoke a provider’s billing privileges, a provider has exhausted all applicable appeal rights or the timeline for appeal has expired, and there is no expectation on the part of a provider or supplier or the Medicare program, State Medicaid program, or CHIP that the revocation is temporary.

Disciplinary Actions (aka Board Actions) is the language used to describe the types of actions that occur at a board level. These can be minor, like a fine or civil penalty. Or they can be major, like a revocation or suspension of a medical license.

The difference between these? Though these both are targeted to the medical world, Disciplinary Actions cannot occur unless you are licensed, or attempting to become licensed. However, anyone can become excluded. Many times, a severe enough action will result in an exclusion, however this is not always the case.

Our dataset has much more than just these sources. We have a myriad of sources that are going to help give you the complete picture on your provider. We include Medicare Opt-Out’s, Abuse Registries, License Conditions, Imposter Alerts, Federal and State Actions, Press Releases, etc. Often times all of these different types of data fall into one category. Sanctions.

It would appear that the term “sanction” has been adopted to include any or all of the possible actions taken by the Federal government, state governments, or boards. As has been noted the terminology used by the many reporting entities varies greatly including;
Exclusion
Termination
Board Action
Medicare Opt-Out
Abuse Registries
License Condition
Imposter List
Federal and State Action
Press Release

That’s why, when asked if we have a sanction dataset, I’m always careful to ask follow-up questions about what specific sources the customer might want or need. If my customer is unsure of what exactly they need, we try to always stay up to date on the compliance regulations so we can offer them exactly what they need to meet the standards.

Let’s Talk about Primary Source Data

What is a Primary Source?

A Primary Source is the original source repository or the source that legally issue licenses, discipline, education, training, or examination. A couple of examples of this in our industry are:

California Board of Registered Nursing
Office of Inspector General, U.S. Department of Health and Human Services (OIG)
Pharmacy Technician Certification Board (PTCB)
Centers for Medicare and Medicaid Services (CMS)

What is a Primary Source Data?

Primary Source Data is the license, certification, or disciplinary data directly from the original source. This means the data we collect is directly from the primary source. This data includes exclusion information, opt-out affidavits, license issuance, and disciplinary records. Another caveat to primary source data is we do not change, adjust, or modify the record found at the primary source.

Why is Primary Source Data Important?

Primary source data is important to your company as a way to confirm that your employee can be authorized to work for your facility.

The OIG has the authority to exclude individuals and entities from participation in federal healthcare programs. Any organization or individual who hires excluded parties may be subject to civil monetary penalties (CMP). To avoid these penalties, the LEIE recommends (as a part of the Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs) that you check their database upon hire, and on an ongoing monthly basis.

Primary Source data is not only important to us, it’s important to accrediting bodies (i.e. The Joint Commission, URAC) and exclusion bodies (i.e. OIG, GSA).

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