Friday,
November 14, 2003
Vol. 6, No. 91
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Solve all of your biggest challenges-AUDITING, KICKBACKS, STARK, HIPAA,TRAINING, AND MEASURING EFFECTIVENESS with reporters who get the stories and ideas you need to comply and help your organization's bottom line!
"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 Kate Alvarez at kalvarez@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
What are the Medicare requirements for dates on physician's orders?
Q:
After reading the Ask the Expert in the October 24th issue of Compliance
Monitor Q&A, I was curious if there was more information on Medicare/Medicaid guidelines regarding the date on a physician's order for outpatient diagnostic tests?
A:
There are not any specific Medicare and/or Medicaid standards on how long a laboratory order is accepted after a physician writes it. When the Centers for Medicare and Medicaid (CMS) processes a claim, it does not compare the laboratory service date against an order date.
However, if a claim is audited, CMS can review the medical record documentation and determine the difference between the laboratory order date and date of service are unreasonable. Based on the clinical condition of the patient, CMS has the discretion to deem the claim not medically necessary if it determines the period between the date of order and the date of service is too long.
In most circumstances, it is prudent for a laboratory order to be completed within a 30-day period unless it is a standing order. This is a general standard of care guideline, not a CMS guideline.
This question answered by Michael A. O'Connell, MHA, FACMPE, CHE, Senior Director, Cleveland Health Network MSO.
moconnell@chnmso.com.
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WE NEED YOUR EXPERTISE!
Join the Compliance Monitor Team! Compliance Monitor Q&A relies upon experts just like you to answer pressing compliance questions. We're looking for experts in coding, billing, documentation, HIPAA, EMTALA, Stark, laboratories, and many other areas of compliance.
If you are interested in answering questions from your peers, please e-mail Compliance Monitor editor Kate Alvarez.
Tips, examples, and recommendations for planning your compliance focus areas and audit topics for the coming year
HCPro can help you use the 2004 Work Plan to your best advantage. Attend the 90-minute live audioconference, "2004 OIG Initiatives: How to Get Ready and Stay in Compliance." Here is what Andy Navarro, Legal Counsel at Trinity Mother Frances Hospital in Tyler, TX, had to say about last year's HCPro program on the 2003 Work Plan for Hospitals:
"Excellent program! This is a must for compliance professionals!"
This program will be held on 12/10/2003. To register, or learn more, click here or call 800/650-6787 and mention source code EZ23867H.
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Tell us about your financial policies.
Click here to take our quick survey on your financial policies and procedures.
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Pay-Per-View article: Beware of HIPAA's seven deadly sins
The Office for Civil Rights (OCR) describes its enforcement of HIPAA's privacy rule as limited, complaint-driven, and largely educational, but this policy is likely to change. The history of health care regulatory programs teaches us that programs starting out as complaint-driven and educational ultimately become punitive and confrontational.
Because the enforcement process is triggered by a complaint submitted to OCR, covered entities should be on the alert for violations that are likely to compel third parties to file a complaint in the first place. Using the complaint trigger as a guide, covered entities that don't want to spend time and money on OCR enforcement should prioritize and minimize their vulnerabilities, and consider an internal audit for the seven deadly HIPAA sins listed in this article.
To find out more on the seven HIPAA sins, order the pay-per-view article
"Beware of HIPAA's seven deadly sins." The cost is $10. Subscribers to the online version of Briefings on HIPAA have free access to this article. Subscribers to the print edition can find it in their November issues.
A $30 steal.
You can read this article and much more in the November issue of
Briefings on HIPAA. Your cost: Five stories for only $30. You'll also learn how a small provider finds ways to keep staff interested in HIPAA privacy, strategies for measuring privacy compliance plan effectiveness, whether the contingency plan for non-Medicare claims is still in place, and about JCAHO/NCQA plans to certify 'business units.'
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2004 OPPS and HCPCS Changes: Update Your Charge Master
Major changes to OPPS and HCPCS codes are expected for 2004! Update your charge master for accurate and maximum reimbursement. Also avoid overbilling mistakes and investigations from the OIG.
Get FREE TRIALS AND DEMONSTRATIONS on easy-to-use charge master products and services from Chargemasters.com, Holliday & Associates, and HCPro. For more information, just click here. To sign up for FREE trials or demonstrations,
click here.
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HIPAA and school records
Q:
Our therapists need to contact physicians and school therapists to discuss certain children they treat. What are the HIPAA guidelines? Will they need parent authorization?
A: To read the answer to this question, click here.
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Quick survey:
Does your organization train employees on Medicaid compliance issues?
To submit your answer, go to the Question of the Week at
Complianceinfo.com.
Here are the answers to the last survey:
When will your organization begin auditing its HIPAA compliance program?
- Within the next six months: 68%
- In 7 to 12 months: 17%
- In 12+ months: 9%
- We do not plan to audit: 6%
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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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Share the news
You've been benefiting from our informative
e-mail newsletter, so why not pass on this resource to your peers? Sign up a colleague and get $20 off your next purchase on HCPro's Healthcare Marketplace!
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Send your comments and questions about Compliance Monitor Q&A to:
Kate Alvarez
Editorial Assistant
kalvarez@hcpro.com
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