Resource Library

PECOS plays a critical role in facilitating communication and data accuracy between providers and CMS. It powers several datasets indicating providers' statuses and standing with CMS.

Learn how to screen your non-employed provider populations (referring, ordering, prescribing physicians with NPI verification and ongoing sanction/exclusion monitoring.

The steady rise in demand for home health and personal care services and lack of certain controls has produced vulnerabilities in government healthcare programs to eliminate fraud, waste, and abuse.

Learn more about the Medicare Opt Out Affidavit list and how to automate provider verification for billing, claims processing, referral networks and more.

Learn more about the provider information found on the CMS Preclusion List, and how it affects Medicare Advantage Plans and Part D prescribers.

Learn how to utilize the NPI Registry to look up physicians and healthcare organizations and learn how NPIs can help make your provider data smarter.

The National Provider Identifier (NPI) number is commonly used to validate and verify authentication, process control, individual claims, contracts/agreements, and much more.

You found an excluded employee in your organization, now what? Likely, your first thought is a bit of panic and a lot of questions. How long has this person worked for us? How did we miss this? What position did they hold? Did we receive federal funds for the job this person held? What do I do now? If there is any good news in this scenario, perhaps it is that the Office of Inspector General (OIG) has given providers direction on how to prepare for a self-disclosure to the OIG via the OIG’s Provider Self-Disclosure Protocol (SDP) document.

Now, What?

So now you've finished your internal audit and have all sorts of new information. Likely some great outcomes and perhaps some that you weren’t expecting. What should you do next? There isn’t one absolute answer but all audit findings have to be looked at and evaluated for appropriate next steps. Some outcomes are more serious than others and will cause a more immediate response, while others may require nothing more than some re-education and follow up next year. Let’s break down some of the possible audit outcomes and next steps so you don't feel like these fish.