Program Integrity Screening definition

Program Integrity Screening means a review of an individual’s or entity’s program integrity history, which may include a review of the individual’s or entity’s history of exclusion or other sanctions imposed with respect to participation in Medicare, Medicaid, or CHIP; history of failure to pay Medicare debts in a timely manner; current or prior law enforcement investigations or administrative actions; affiliations with individuals or entities that have a history of program integrity issues; and other information pertaining to the trustworthiness of the individual or entity.
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Program Integrity Screening means a review of an individual’s or entity’s program integrity history, which may include a review of Medicare or Medicaid, or any combination of the two, program exclusions or other sanctions, current or prior law enforcement investigations or administrative actions, affiliations with individuals or entities that have a history of program integrity issues, or other information pertaining to the trustworthiness of the individual or entity.
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Program Integrity Screening means a review of an individual’s or entity’s program integrity history and current status, which may include, but is not limited to, a review of the individual’s or entity’s eligibility, history of exclusion, investigations, probations, actions or corrective action plans or other sanctions imposed with respect to participation in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP), history of failure to pay Medicare debts in a timely manner, current or prior law enforcement investigations or administrative actions, affiliations with individuals or entities that have a history of program integrity issues, and other information pertaining to the trustworthiness of the individual or entity.
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Examples of Program Integrity Screening in a sentence

  • CMS shall conduct a Program Integrity Screening for each individual and entity on the Proposed Revised Participant Provider List and the Proposed Revised Preferred Provider List.

  • Any such requests shall be made in accordance with the procedures set forth in section 5.2, except that CMS need not conduct a Program Integrity Screening in the case of a request to make a late addition to the certified Care Partner List or a request to increase the number of CRP Tracks in which a Care Partner or Downstream Care Partner is participating.

  • After reviewing the Program Integrity Screening results, CMS shall submit to the Hospital, by the deadlines specified in the CRP Calendar, an approved Care Partner List identifying the individuals and entities that CMS has approved to be Care Partners and Downstream Care Partners for the Performance Period.

  • CMS states that it conducted a Program Integrity Screening for each individual or entity the ACO proposed to add to its Proposed Participant Provider List and Proposed Preferred Provider List and reserved the right to reject any individual or entity proposed for inclusion on the basis of the criteria described in Section 4.02.E.

  • CMS shall conduct a Program Integrity Screening for each individual and entity on the Proposed Revised DC Participant Provider List and the Proposed Revised Preferred Provider List.

  • CMS states that it conducted a Program Integrity Screening for each individual or entity the DCE proposed to add to its Proposed DC Participant Provider List and Proposed Preferred Provider List and reserved the right to reject any individual or entity proposed for inclusion on the basis of the criteria described in Section 4.02.E.

  • CMS may also conduct a Program Integrity Screening on the Participant and any NPRA Sharing Partner, NPRA Sharing Group Practice Practitioner, and BPCI Advanced Entity previously identified on the Financial Arrangement List.

  • CMS may reject any Downstream Episode Initiator listed on the initial Participant Profile on the basis of the results of a Program Integrity Screening, history of program integrity issues, or if CMS determines that the entity does not satisfy the definition of an Episode Initiator.

  • After reviewing the Program Integrity Screening results, CMS shall submit to the Hospital, by the deadlines specified in the CRP Calendar, an approved Care Partner List identifying the individuals and entities that it has approved to be Care Partners and Downstream Care Partners for the Performance Period.

  • CMS may reject a request to add an individual or entity to the Participant Provider List if the individual or entity fails to satisfy the requirements of paragraphs (1) through (5) of Section 4.01.A, on the basis of information obtained from a Program Integrity Screening or history of program integrity issues, or as authorized under Section 4.03.A.

Related to Program Integrity Screening

  • Screening means the process to determine whether the person seeking assistance needs further comprehensive assessment.

  • Health screening means the use of one or more diagnostic tools to test a person for the presence or precursors of a particular disease.

  • Collaborative drug therapy management means participation by an authorized pharmacist and a physician in the management of drug therapy pursuant to a written community practice protocol or a written hospital practice protocol.

  • UMDAP means the Uniform Method of Determining Ability to Pay and refers to the 20 method used for determining the annual Consumer liability for Mental Health Services received from 21 the COUNTY mental health system and is set by the State of California.

  • E-Verify Program above means the employment verification program administered by the United States Department of Homeland Security, the Social Security Administration, or any successor program.