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News and real-life examples to increase the effectiveness of your compliance program. Strategies for Health Care Compliance will be your guide for avoiding fraud and maintaining compliance.

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Strategies for Health Care Compliance

Issue 8, August 1, 2003

• Evaluation and management outpatient codes

  Download this evaluation and management outpatient codes worksheet to use in your own facility.

Issue 1, January 1, 2003

• Training

  Training

Issue 12, December 1, 2003 - VIEW THE FULL ISSUE

• You have a qui tam relator

  Each year the government increases the number of qui tam cases it pursues. In 2002, the government...

• Patient Financial Policy

  Co-Pays The patient is expected to present an insurance card at each visit. All co-payments and...

• Solutions for drafting Stark compliant physician contracts

  The Stark Law is so intricate that it can even trip up compliance officers and legal counselors...

• Case study: How to develop a financial policy

  Case study: How to develop a financial policy

• The cost of compliance

  The case: A hospital system in New Jersey recently challenged the Office of Inspector General's...

Issue 11, November 1, 2003 - VIEW THE FULL ISSUE

• Work Plan: Your key to prioritizing this year's compliance efforts

  Need some motivation to prioritize your compliance efforts for 2004? The Office of Inspector...

• EMTALA: Six easy steps for tackling the rule's changes

  Hospitals must understand the changes to the Emergency Medical Treatment and Labor Act (EMTALA) of...

• EMTALA: How to respond to a potential violation

  If your hospital violates EMTALA, you will have precious little time to mitigate the potential...

• Electronic claims rule implicates privacy, security

  With few exceptions, providers must submit all claims to Medicare electronically as of October 16...

• The next step in credentialing: Compliance in the medical staff office

  In light of the increasing False Claims Act (FCA) exposure of hospitals for failed credentialing...

• Policy: Search warrants

  Federal and state law enforcement agencies are increasingly using search warrants in conjunction...

Issue 10, October 1, 2003 - VIEW THE FULL ISSUE

• Outliers: Perform self-assessments to analyze your facility's risk

  Months ago, fiscal intermediaries (FIs) identified the hospitals they planned to audit on-site and...

• We've investigated, now what?

  Guidelines for self-disclosing Part two of three Now that you have completed an internal...

• Watch private payer mandates, as HIPAA court ruling proves

  Buried in the comprehensive Health Insurance Portability and Accountability Act of 1996 (HIPAA...

• Draft Model Disclosure letter to Fiscal Intermediary

  Download this sample disclosure letter to fiscal intermediary so that you can modify it for your...

Issue 9, September 19, 2003 - VIEW THE FULL ISSUE

• Internal/government investigations: Answers to your toughest questions

  Part one of three Are you prepared to respond to a billing problem at your organization? How...

• Chargemaster: Accurate information is the secret to clean claims

  Develop a plan for making annual updates to your facility's CDM and ensuring that staff make every...

• Strategies for examining diagnostic testing in the ER

  The quick and urgent pace of patient treatment in the emergency room (ER) opens it to myriad...

• Compliance tips for meeting the HIPAA security rule access control standards

  Organizations must control access to protected health information (PHI) to reasonably ensure that...

• New tips to help you monitor privacy compliance, avoid OCR inquiry

  You lived through April 14th. Employees are now distributing privacy notices, collecting...

• HIPAA auditing program

  Consider following UHC's 12-step program for auditing HIPAA compliance University Health Care...

• Sample 12-step program for auditing

  HIPAA compliance University Health Care (UHC), in Columbia, MO, includes the following 12...

Issue 8, August 1, 2003 - VIEW THE FULL ISSUE

• The ABCs of responding to Medicare audit letters

  How you respond to a Medicare audit request is crucial-it's your first chance to get government...

• Security rule: Risk analyses help prioritize your efforts

  Conducting a security risk analysis will help you determine where to spend your time and money-and...

• Clinical trials: Getting it right with adverse events

  The government is concerned about whether clinical researchers are reporting adverse events to...

• Five sure-fire training tips for E/M coding

  Physicians should be reimbursed for the services they provide. Evaluation and management (E/M...

• Whistleblower retaliation laws pose compliance challenges

  Lost in the hoopla over other provisions of the Sarbanes-Oxley Act (SOX) were two new whistleblower...

Issue 7, July 26, 2003 - VIEW THE FULL ISSUE

• Strategies for measuring privacy program effectiveness

  Measuring privacy program effectiveness has many benefits-it will help your organization focus...

• Physician training: Tips and techniques for educating docs

  When your physicians violate the government's fraud and abuse rules, they put your organization in...

• Physician handout: Anti-kickback issues

  Twenty-five years ago, kickbacks in health care meant physicians who paid cash for referrals...

• Bulletin: OIG targets contractual joint ventures

  The Office of Inspector General (OIG) has renewed its interest in contractual joint venture...

Issue 6, June 23, 2003 - VIEW THE FULL ISSUE

• Stark: Problem-solving strategies for analyzing self referrals

  Stark law violations can cost a facility in civil monetary penalties, exclusion from government...

• Tips for drafting business associate agreements

  Your organization must review all of its contracts with vendors and outside entities. Sound scary...

• Compliance leaders speak out about quality of care

  Compliance officers are more involved than ever in the quality of care crisis in America's...

• Consider yourself warned: Criminal responsibility for overutilization

  Criminal prosecutions of institutional health care providers are rare, especially for claims of...

Issue 5, May 17, 2003 - VIEW THE FULL ISSUE

• Strategies for Health Care Compliance, May 2003

  Inside: Validate compliance program effectiveness through auditing Use attorney-client...

• Validate compliance program effectiveness through auditing

  You can have a great auditing and monitoring program, the right committees, a super code of...

• Use attorney-client privilege to keep your compliance files under wraps

  Inquiring minds may want to know, but letting your sensitive compliance material fall into the...

• Cost-saving measures for transactions testing

  There is no rest for the weary. On April 16, just two days after the privacy rule's deadline...

• Hot trends in antitrust enforcement: PHOs and Mergers

  Second in a two-part series on antitrust laws Last month, we explored the statutory framework of...

• Health plan adopts credentialing compliance program

  How can a health plan prevent unqualified or even phony practitioners from treating its members...

Issue 4, April 1, 2003 - VIEW THE FULL ISSUE

• Rehnquist steps down as IG amidst controversy

  Janet Rehnquist resigned from her post as head of the Office of Inspector General (OIG) on March 4...

• Final security regs place more emphasis on risk assessment

  Those who thought the proposed security rule requirements were too burdensome can stop...

• Inside CMS' outlier investigation

  If your hospital has raised prices aggressively over the last few years, it may be time to prepare...

• Compliance is more than Medicare fraud

  Without a doubt, compliance officers in the health care sector spend an overwhelming amount of...

• Security management process

  Editor’s note: This policy was excerpted from the HIPAA Guidelines Policy and Procedure...

• Compliance issue resolution

  Compliance issue resolution

Issue 3, March 1, 2003 - VIEW THE FULL ISSUE

• Work Plan: Hospital billing and coding under close OIG scrutiny

  The Office of Inspector General's (OIG) 2003 Work Plan includes many projects that have become...

• The inside scoop: How the OIG's pharma guidance affects providers

  The days of drug companies flying physicians to Hawaii for a five-day vacation interrupted...

• APCs: Make sure your organization has effectively implemented the 2003 changes

  The 2003 outpatient prospective payment system (OPPS) final rule affects all sides of the health...

• OIG offers advice on malpractice payments

  Lately it seems as though each day the newspapers feature physicians on strike to protest...

• Sample conflict of interest policy

  [The Clinic of Hospital] and its physicians, staff, managers, and employees are subject to an...

Issue 2, February 1, 2003 - VIEW THE FULL ISSUE

Issue 1, January 1, 2003 - VIEW THE FULL ISSUE

• Accounting of disclosures of protected health information

  Accounting of disclosures of protected health information

Issue 12, April 24, 2003

• Security management process

  Security management process

Issue 8, February 25, 2003

• CCO Reader Survey

  CCO Reader Survey

• Conflict of interest policy for Medical Clinic in Wisconsin

  Conflict of interest policy for Medical Clinic in Wisconsin

Issue 2, February 21, 2003

• Draft compliant medical director and administrative services agreements

  Second in a three-part series.“No contract, no payment” is the rule that Daniel...

• Economic credentialing: OIG needs your help

  By Mark L. MattioliOn December 9, 2002, the Office of Inspector General (OIG) invited providers...

• HIPAA enforcer: Privacy rule investigations will be complaint-driven

  Health care organizations aren't the only ones preparing for the privacy rule compliance...

• Include commercial insurance regulations in your compliance plan

  If you think you only need to worry about complying with Medicare billing regulations, think...

Issue 1, January 21, 2003

• 23 New Year’s compliance resolutions

  In addition to dieting and working out this new year, vow to expand and improve your...

• OIG Work Plan

  By Mark L. MattioliAn effort may be underway to examine hospital quality violations as potential...

• The new generation of compliance

  Create compliant hospital-physician financial arrangementsPart one of a three-part seriesEntering...

• Training tips and BA agreement hints

  Health care organizations have entered the final stretch toward meeting the privacy rule’s...