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* How do we perform a criminal background check?
* ABNs, routine and not
* Pay-per-view article: HIPAA countdown: Conduct privacy assessments to verify effectiveness

Compliance Monitor, March 21, 2003

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How do we perform a criminal background check?

Q: How should we go about performing a criminal background check on a potential employee or physician? I've read that it is relatively inexpensive and does not require a lot of time, but I have no idea what is involved in this process.

A: Yes, criminal background checks can be inexpensive, but they are time consuming as do-it-yourself projects. One of the biggest problems in doing a thorough check is being sure you've checked all potential sources. If you could access the FBI's database, which most private entities can't, it would simplify your job. Unfortunately, criminal records reside in numerous places, even within a single county. Your local police agencies maintain these records, as do the court systems. But every state has a different system, so call them and ask. Remember to check places where the individual has lived. You may have to check several jurisdictions in different parts of the country.

Interpreting the records can also be a challenge for the novice. If that sounds daunting, there are a number of private companies that will perform criminal background checks and credit checks for you.

You should always check the Office of Inspector General's (OIG) list of excluded providers and the General Services Administration (GSA) list of barred contractors. These checks are inexpensive, and they're worth it for the peace of mind. Always check the OIG and GSA lists when you hire new physicians or other employees, and then go back to these lists annually to check on anyone who's billing federally funded healthcare programs. Remember, excluded individuals and entities may not receive compensation in any way from federal funds.

These lists are available online at the following Web sites:

Click here for the OIG List of Excluded Individuals/Entities.

Click here for the GSA List of Parties Excluded From Federal Procurement and Non-procurement Programs.

This question was answered by Charles Colitre, president of Med-Management Group, Inc., a consulting firm in Akron, OH that assists physician practices and hospital systems to develop and implement compliance programs. Colitre is also a retired FBI Supervisory Agent who supervised health care fraud investigations.

Go to "HIPAA countdown: Conduct privacy assessments to verify effectiveness" for the rest of this article. The cost is $10. Subscribers to the online version of Health Care Auditing Strategies have free access to this article. Subscribers to the print edition can find it in their March issues.

A $30 steal!

You can read this article—and much more—in the entire March issue of Health Care Auditing Strategies. Your cost: Four stories for only $30! You'll learn how to integrate the OIG's assessment and analysis process with mock audits, and why compliance and auditing are a match made in heaven. Choose between a PDF or HTML version for just $30. Online subscribers have free access to this issue. Print newsletter subscribers can find it in their mailboxes.

Q: Can we legally have patients sign a routine advance beneficiary notice (ABN) for positron emission tomography (PET) scans? It seems that the majority, if not all of our PET scans are denied by Medicare.

A: A practice cannot legally have patients sign a routine advance beneficiary notice (ABN) for positron emission tomography (PET) scans. Medicare specifically prohibits the use of "routine" ABNs.

First some background: An ABN is a document that tells a patient that Medicare or another insurance plan may not cover a particular service or procedure. This gives the patient a chance to deny services before your staff delivers them. ABNs list the estimated cost of these services. This notifies patients of their financial responsibility in the event their insurer does not cover the service. By providing an ABN, you've given the patient appropriate informed consent about the service, its medical necessity, and the likelihood the insurer will pay for it.

A local medical review policy (LMRP) has been developed regarding ABNs and PET scans. The policy includes an LMRP description, indications and limitations of coverage and/or medical necessity, general conditions of coverage, diagnosis codes that support medical necessity, and reasons for denial. This policy should give providers all the information necessary to determine whether the PET scan will be covered. If the physician has ordered the PET scan and it appears that Medicare will not cover the test, then you would need to offer the patient a chance to sign an ABN.

For further information about ABNs and Medicare, go to the official web site of the Centers for Medicare and Medicaid Services and type ABN in the search function.

This question was answered by Michael O'Connell, MHA, CMPE, CHE, senior director of the Cleveland Health Network MSO, LLC, in Independence, OH.

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