Centers for Medicare & Medicaid Services (CMS) Opt Out List

CMS (Centers for Medicare & Medicaid Services) is the federal agency, formerly known as the Health Care Financing Administration or HCFA, within the DHHS that runs the Medicare and Medicaid programs. The Medicare Opt-Out is a list of providers who have signed private contracts with Medicare beneficiaries and have therefore “opted out” of the Medicare program. If confirmed on the Medicare Opt-Out list, actions need to be taken as relevant to the Screened Person unless there are stringent procedures to ensure that this Screened Person will not provide services to Medicare members or this Screened Person is employed in a non-clinical, administrative role.

There are CMS Medicare Opt Out lists available for each state. Each list is maintained by a different agency and might be in a different format. Due to the diverse formats it becomes very difficult to screen against several different states and to keep the lists up to date. ISTmedWatch can process and update the CMS Opt Out lists automatically, just tell us which states you need to screen.

ISTmedWatch can search the latest version of the CMS Opt Out lists and offers batch and interactive search capabilities. The data is automatically updated without manual intervention ensuring that customers are always current. ISTmedWatch is designed to automate the CMS Opt Out screening process and to keep record of the processed records for audit and compliance purposes. In addition to CMS Opt Out, ISTmedWatch can search against OIG LEIE, CMS opt out, OFAC SDN and other custom user supplied lists.

The main advantages of ISTmedWatch are:

• Easy to use, automated processing
• Automatic data format processing and updates with no manual intervention
• Extensive reporting, auditing and transaction logging
• Advanced, fuzzy searching and matching engine ensuring even inexact matches are found
• Built-in exclusion (false positives) processing