Healthcare exclusion screening glossary
The terms that come up when an organization checks its people and vendors against exclusion lists, each defined in a sentence and backed by the official source.
- Excluded individual or entity
- A person or organization that is currently subject to an exclusion and listed on the LEIE or a state Medicaid list. The programs it covers do not pay for any items or services they furnish, order or prescribe, directly or through someone else.
- Exclusion
- An exclusion is an action by the HHS Office of Inspector General (OIG) or a state Medicaid program that bars a person or organization from federal or state health care programs. No program payment is made for items or services they furnish, order or prescribe.
- Exclusion screening
- Exclusion screening is checking the names of employees, contractors, vendors and owners against exclusion lists, before working with them and then on a schedule. Most health care organizations check monthly.
- Mandatory and permissive exclusion
- The two kinds of OIG exclusion. A mandatory exclusion is required by law after certain convictions and lasts at least five years; a permissive exclusion is imposed at OIG’s discretion on other grounds.
- Medicaid exclusion
- A Medicaid exclusion bars a person or organization from a state’s Medicaid program. It can come from OIG, which covers every state, or from the state Medicaid agency itself, which publishes its own list.
- Medicare exclusion
- A Medicare exclusion is an OIG exclusion seen from Medicare’s side: there is no separate Medicare list. A person or organization on the LEIE is barred from Medicare and from every other federal health care program at once.
- NPI (National Provider Identifier)
- An NPI is the unique 10-digit number every HIPAA-covered health care provider uses on claims, issued through the CMS NPPES system. It identifies a provider without carrying any information about them.
- OIG LEIE
- The LEIE (List of Excluded Individuals/Entities) is the HHS Office of Inspector General’s database of every person and organization currently barred from federal health care programs. OIG republishes it every month.
- Potential match
- A potential match is a name in your records that resembles an entry on an exclusion list. It needs verification before it means anything: many people share a name.
- Reinstatement
- Reinstatement is OIG’s written decision that ends an exclusion and lets a person or organization take part in federal health care programs again. It is not automatic when the exclusion period ends.
- SAM.gov exclusion
- A SAM.gov exclusion is a record in the federal System for Award Management showing that a person or organization may not receive federal contracts, grants or other federal assistance. The General Services Administration runs SAM.gov.
- Sanctions screening
- Sanctions screening is the industry name for checking people and organizations against government exclusion, debarment and sanction lists. In health care it usually means the LEIE, SAM.gov and state Medicaid lists.