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

2. 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?

3. Outpatient Orders
Considerations
Current Policy?
State Law
Federal Law

4. 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?

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

6. Outpatient Orders Develop Policy & Procedure Legal Input
Outpatient Department Input

7. Outpatient Orders
License Verification
OIG Exclusion
Privileges?

8. Outpatient Orders Outpatient Hours Database / Ongoing Monitoring
Individual Verifications

9. QUESTIONS