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Who should check the Medicare Exclusions list?

Provided by:  Jennifer Kirschenbaum, Esq.
Question:
Hi Jennifer,
 
I own an answering service and consider myself a business associate, but when I hire, do I have an obligation to check the Medicare Excluded Providers list? 
 
Thanks, 
P
Answer: 
 
P, glad to hear you consider your company a business associate, which allows me to presume you do have in place a business associate agreement with your clients.  You are handling protected health information when taking patient calls, so even if you have no access to your clients' EMRs (which I'm sure you do not), a business associate agreement entirely appropriate.  Be sure to use one with indemnification in your favor, if possible, and if you don't have one with indemnification, you can order our Business Associate Agreement here for a flat fee.  
As to checking the Medicare Excluded provider list, you could err on the side of caution and check since its a click away. Click here to check it out - https://exclusions.oig.hhs.gov/. However, if I am understanding job functionality, where an employee takes after hour calls and delivers messages to practitioner offices - I do not see necessarily see a correlation directly to issues with Medicare and reimbursement, because in the role of answering service employee, that person would not have access to the client's electronic medical record for claims submission.  If the concern would be that the employee would somehow develop a scheme to solicit money from patients calling the service, that person would clearly be engaging in a heinous act of deception, where checking the excluded persons list would have been helpful, but likely your background check moreso.  
To err on the side of caution - I recommend you check.  Doesn't hurt.  If you haven't checked or don't want to check, would it be used against you later?  Depends on the circumstances.  
Provided by: Jennifer Kirschenbaum, Esq.
January 19, 2017
Question:

Hi Jennifer,
 
I own an answering service and consider myself a business associate, but when I hire, do I have an obligation to check the Medicare Excluded Providers list? 
 
Thanks, 
P


Answer: 
 
P, glad to hear you consider your company a business associate, which allows me to presume you do have in place a business associate agreement with your clients.  You are handling protected health information when taking patient calls, so even if you have no access to your clients' EMRs (which I'm sure you do not), a business associate agreement entirely appropriate.  Be sure to use one with indemnification in your favor, if possible, and if you don't have one with indemnification, you can order our Business Associate Agreement here for a flat fee.  

As to checking the Medicare Excluded provider list, you could err on the side of caution and check since its a click away. Click here to check it out - https://exclusions.oig.hhs.gov/. However, if I am understanding job functionality, where an employee takes after hour calls and delivers messages to practitioner offices - I do not see necessarily see a correlation directly to issues with Medicare and reimbursement, because in the role of answering service employee, that person would not have access to the client's electronic medical record for claims submission.  If the concern would be that the employee would somehow develop a scheme to solicit money from patients calling the service, that person would clearly be engaging in a heinous act of deception, where checking the excluded persons list would have been helpful, but likely your background check moreso.  

To err on the side of caution - I recommend you check.  Doesn't hurt.  If you haven't checked or don't want to check, would it be used against you later?  Depends on the circumstances.  

For sure any vendor or treating provider involved with patient care and certainly claims submissions must check the Excluded Providers list before employing.

Question:
Hi Jennifer,
 
I own an answering service and consider myself a business associate, but when I hire, do I have an obligation to check the Medicare Excluded Providers list? 
 
Thanks, 
P
Answer: 
 
P, glad to hear you consider your company a business associate, which allows me to presume you do have in place a business associate agreement with your clients.  You are handling protected health information when taking patient calls, so even if you have no access to your clients' EMRs (which I'm sure you do not), a business associate agreement entirely appropriate.  Be sure to use one with indemnification in your favor, if possible, and if you don't have one with indemnification, you can order our Business Associate Agreement here for a flat fee.  
As to checking the Medicare Excluded provider list, you could err on the side of caution and check since its a click away. Click here to check it out - https://exclusions.oig.hhs.gov/. However, if I am understanding job functionality, where an employee takes after hour calls and delivers messages to practitioner offices - I do not see necessarily see a correlation directly to issues with Medicare and reimbursement, because in the role of answering service employee, that person would not have access to the client's electronic medical record for claims submission.  If the concern would be that the employee would somehow develop a scheme to solicit money from patients calling the service, that person would clearly be engaging in a heinous act of deception, where checking the excluded persons list would have been helpful, but likely your background check moreso.  
To err on the side of caution - I recommend you check.  Doesn't hurt.  If you haven't checked or don't want to check, would it be used against you later?  Depends on the circumstances.  
For sure any vendor or treating provider involved with patient care and certainly claims submissions must check the Excluded Providers list before employing.


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