Things that make you go Hmmmm?! North Carolina Association Medical Staff Services May 13, 2016 Renee Aird Dengler, RN, MS, CPMSM, CPCS

Outpatient Orders Scenario: A patient presents to the Outpatient Department with an order for ________________________ . The practitioner who wrote the order is not a member of your medical staff and has not been credentialed and/or privileged with your organization. What do you do?

Outpatient Orders Considerations Current Policy? State Law Federal Law

Outpatient Orders Is the practitioner licensed in your State? Do they need to be licensed in your State? Is the order for a test or a treatment? Does their license allow them to order the test/treatment?

Outpatient Orders Medicare/Medicaid Fraud/Abuse Exclusion Monetary Penalties Known or Should have Known

Outpatient Orders Develop Policy & Procedure Legal Input Outpatient Department Input

Outpatient Orders License Verification OIG Exclusion Privileges?

Outpatient Orders Outpatient Hours Database / Ongoing Monitoring Individual Verifications

QUESTIONS