Friday,
August 1, 2003
Vol. 6, No. 61
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"Strategies for Health Care Compliance," a 12-page monthly newsletter, helps you thrive in the ever-changing compliance environment by providing easy-to-understand compliance advice and analysis of the latest regulations. Each month, this newsletter offers how-to tips, features about your peers, policies and procedures, and tools for improving the efficiency and effectiveness of your corporate compliance programs. To learn more, click here or
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On Complianceinfo.com
Sample compliance policies and procedures. (For subscribers to Strategies for Health Care Compliance only)
Sample audit programs. (For subscribers to Health Care Auditing Strategies only)
The OIG Work Plan for Fiscal Year 2003
Ask the Expert
Compliance Hot Topics: Billing and Coding, EMTALA, Stark, HIPAA
Question of the Week
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Welcome to Compliance Monitor Q&A!
Our mission is to answer your difficult compliance questions-and your simple ones, too. To submit a question, send it to Compliance Monitor Q & A editor Melissa Osborn at mosborn@hcpro.com.
We hope you enjoy this service and we welcome your feedback.
This week's questions
Pay-per-view article
Quick survey
Questions and Answers
Are insurance companies business associates under HIPAA?
Q:
Many of the insurance companies our hospital deals with say they are not our business associates; therefore, they won't sign our business associate agreement. Are insurance companies considered business associates under the Health Insurance Portability and Accountability Act (HIPAA)?
A:
They are correct. Insurance companies are not business associates. Hospitals, other health care providers, and the insurance companies to which they submit claims are not business associates under typical circumstances.
At a simplified level, the core function of hospitals is to provide health care, and the core function of health insurance companies is to pay for it. While these covered entities need to interact and share protected health information (PHI) to accomplish these functions, they are not working for each other.
However, if one is performing additional services for or on behalf of the other, like an insurance company that provides data aggregation services for the hospital, and the work requires access to or release of PHI, then the former becomes the latter's business associate. In the example, the insurer would become the hospital's business associate and a business associate agreement would be necessary.
This question was answered by Kate Borten, CISSP. Since managing the first comprehensive information security programs at Massachusetts General Hospital in the mid '90s and later at CareGroup, she formed The Marblehead Group, Inc., a national security and privacy consulting firm focused on the health care industry.
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Do your auditing and monitoring practices meet OIG standards?
Health Care Auditing Strategies, the 12-page monthly newsletter, can help you get the most out of your audits. It offers practical how-to articles, sample policies and procedures, best practices, and auditing techniques for specific areas, including coding systems, billing systems, cost reports, credentialing processes, employee background checks, education and training programs, and quality of care.
For more information, including how you can save 10%, go to http://www.hcmarketplace.com/Prod.cfm?id=1331&s=EN1614C
Or, call 800/650-6787 and mention Source Code EN1614C.
New ezine: Health Care Auditing Weekly
Setting up and maintaining an auditing program is never an easy task, but HCPro now offers a free resource that delivers helpful news and advice each week!
Introducing Health Care Auditing Weekly, the new e-mail newsletter designed for healthcare internal auditors and compliance professionals. Click here to sign up for your complimentary subscription.
Pay-Per-View article:
Make your coding department a well-oiled machine
In the June BCCS, we talked about various recruiting efforts. Now that coder candidates have responded to your call, you must determine the best candidates and take advantage of their full potential. Preemployment testing can be a very helpful part of the hiring process-but only if you apply your test fairly...
Go to "Make your coding department a well-oiled machine" for the rest of this article. The cost is $10. Subscribers to the online version of Briefings on Coding Compliance Strategies have free access to this article. Subscribers to the print edition can find it in their July issues. Click here to read the first story in this series "Find coders through conventional and unconventional methods."
A $30 steal!
You can read this article-and much more-in the July issue of Briefings on Coding Compliance Strategies. Your cost: Three stories for only $30! You'll learn
how CMS' new outlier rule could affect your facility, how to make your coding department a well-oiled machine, how to create facility-specific coding guidelines, the difference between coding aneurysms, dissections, and pseudoaneurysms, and much more.
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A how-to resource for conducting successful internal investigations and audits
The new book, "See for Yourself: A Health Care Provider's Guide to Conducting Internal Investigations and Audits," will show you how to conduct your own internal investigations and audits from start to finish. It offers practical advice and real-life examples on how to plan and staff an internal investigation or audit, and provides detailed information on the legal issues involved.
To order, or learn more, go to: http://www.hcmarketplace.com/Prod.cfm?id=1742&s=EB1054G
Or, call 800/650-6787 and mention source code EB1054G.
Should we bill outpatients as emergency visits?
Q:
We have patients who present to the emergency department (ED) and their physicians request the following services: that we insert a foley, replace a peg tube, change a dressing, etc. In these cases, may we bill for an emergency department (ED) visit and the procedure that we perform? These patients are registered as outpatients rather than as ED patients.
A: To read the answer to this question, click here.
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Quick survey:
When will your organization begin auditing its HIPAA compliance program?
To submit your answer, go to the Question of the Week at
Complianceinfo.com.
Here are the answers to the last survey:
Would you be interested in learning how other
organizations structure their compliance, privacy, and risk management functions, set procedures, train new employees, and handle reporting and budgets?
- Yes: 96%
- No: 2%
- I'm not sure what impact the rule will have on our
reimbursement: 2%
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Network with your audit colleagues
"Audit Talk" is a new, moderated chat forum that members can use to post messages or questions for their peers 24-hours-a-day. "Audit Talk" offers a free forum to network, share ideas, and solve problems for those in the audit industry. Getting involved is easy. To subscribe, just send your request to this e-mail: owner-audit_talk@hcpro.com.
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Send your comments and questions about Compliance Monitor Q&A to:
Melissa Osborn
Managing Editor
mosborn@hcpro.com
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