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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 12, December 1, 2004 - VIEW THE FULL ISSUE

• Ten steps to assess risk and evaluate controls

  Get more out of your audits by using a risk-based approach instead of traditional audit...

• Keep HIPAA retraining fresh

  Eyes glazed over. Notebooks full of doodles. The phrase "in one ear and out the other" epitomized...

• Investigator-initiated research: Opportunities, obstacles

  Clinical trials have received a great deal of attention from the national media in recent months...

• MS hospital turns to computers to ensure compliance

  At Forrest General Hospital in Hattiesburg, MS, ensuring compliance is no small matter. With one...

• New Employee Corporate Compliance Training Instructions

  New Employee Corporate Compliance Training Instructions

Issue 11, November 1, 2004 - VIEW THE FULL ISSUE

• CMS program integrity changes provide map for coming year

  This fall, James Bryant outlined CMS' intentions, changes, and challenges to its program integrity...

• A step-by-step guide to Stark compliance

  The Stark law's fine print can be a tough nut to crack, and Phase II's exceptions are no...

• Increase reimbursement through necessity audits

  Each year, healthcare facilities face increasing pressure to remain financially viable as the cost...

• HIPAA and human biological materials

  There's a good deal of controversy over ownership and utilization of human biological materials...

• Procedure: forming a medical necessity compliance committee

  A medical necessity compliance committee can help your organization achieve a more streamlined...

Issue 10, October 1, 2004 - VIEW THE FULL ISSUE

• In light of the first HIPAA privacy conviction, education takes center stage

  This summer, HIPAA played a starring role in a federal criminal conviction for the first time...

• Taking the fear factor out of your compliance program

  Compliance is a heavy topic, so infusing compliance teams with a new dynamic and a fresh...

• Make annual notices work for your laboratory

  Picture this: A hospital's compliance officer meets with a physician to discuss lab ordering...

• Identity theft action plan

  In August, when a Washington state cancer center worker was convicted in federal court for...

• Billing Medicare for research-related injuries

  In most clinical trial documents, such as an informed consent or clinical trial agreement, there's...

Issue 9, September 1, 2004 - VIEW THE FULL ISSUE

• The charity-care conundrum

  There are approximately 44 million uninsured people in the United States, and nonprofit hospitals...

• Overturning ED testing denials requires documentation scrutiny

  If you receive denials for reasonable and necessary tests performed in your emergency department...

• Evaluate preventive-visit and problem-visit documentation in seven easy steps

  When it comes to reviewing levels of physician services, it is crucial to distinguish between...

• Look beyond encryption to secure e-mail

  Both the privacy and security regulations require facilities to protect patients' electronic...

• Sliding scale policy

  One hospital uses this sliding scale based upon federal poverty guidelines to determine discounts...

Issue 8, August 1, 2004 - VIEW THE FULL ISSUE

• Documenting undocumented immigrants

  In line with the Medicare Prescription Drug, Improvement and Modernization Act of 2003, (MMA...

• Evaluating physician coding profiles

  Evaluating physician coding profiles is crucial to correct faulty processes and optimize your...

• OIG's compliance guidance outlines risk areas

  New guidelines from the OIG give hospitals instructions regarding what risk areas they should focus...

• Blowing the whistle on research

  Institutions and researchers who misuse federal research grant funds should be aware of a powerful...

• Sample physician coding profile report

  Sample physician coding profile report

Issue 7, July 1, 2004 - VIEW THE FULL ISSUE

• CMS clarifies EMTALA compliance

  Hospitals now have more information concerning compliance with the Emergency Medical Treatment and...

• Compliance, revenue cycle converge

  The role of compliance professionals is constantly evolving, and as definitions expand, so do...

• Add value by safeguarding your organization's goals

  Revised federal-sentencing guidelines make risk assessments and internal controls formal...

• One year into HIPAA, research hits some snags

  It's been more than a year since the HIPAA privacy rule went into effect and everyone from...

• IPPS proposed rule links quality, payment

  The 2005 proposed rule for the inpatient prospective payment system not only provides financial...

• Painting a picture of health

  The revenue cycle scorecard provides a tracking mechanism to determine your success in meeting...

Issue 6, June 1, 2004 - VIEW THE FULL ISSUE

• How compliance and quality intersect

  Some said United Memorial Hospital turned a blind eye when its top anesthesiologist-Jeffrey...

• Compliance moves up the ladder

  The U.S. Sentencing Commission took a tough stance on compliance April 13 when it proposed to amend...

• Using adapted devices can create risks for hospitals

  When the Alfred I. DuPont Hospital for Children filed a corrective-action plan in April after an...

• Review your utilization-management program

  If your audits only focus on business aspects of your organization, you could be ignoring important...

• Snap to it: One facility's camera-phone policy

  The following was added to The (Springfield) Ohio Masonic Home's policy under "use of photographic...

Issue 5, May 1, 2004 - VIEW THE FULL ISSUE

• California patient-privacy suit sparks HIPAA questions

  When the California Consumer Health Care Council (CCHCC) filed a representative-action lawsuit...

• Attorneys weigh in on Stark II, Phase II highlights, clarifications

  Since 2001, the healthcare industry has been anticipating the second phase of the Stark II law on...

• How to create a successful monitoring program for your facility

  Auditing on its own is not enough to maintain an effective compliance program-organizations must...

• Four tips to ease lab compliance woes

  When it comes to tackling the toughest areas of compliance in a laboratory setting, it's crucial to...

• Sample policy: ABNs and medical necessity in the lab

  The following policy excerpt is from St. Mary Mercy Hospital's manual for outpatient pathology and...

Issue 4, April 1, 2004 - VIEW THE FULL ISSUE

• Thoroughly review claims denials to increase your facility's cash flow

  Claims payments and denials are the "pass/fail grade of the revenue cycle," says Jean Lambert...

• Conflicts of interest can put human subjects at risk during clinical trials

  Editor's note: Kendra Dimond, Esq., at Epstein, Becker & Green PC, in Washington, DC, and F. Lisa...

• Don't let discharge planning cost your facility

  Discharge planning is a high-risk area for all hospitals. Baylor University Medical Center (Texas...

• Physician incident-to services

  The Office of Inspector General (OIG) plans to review physician billing of incident-to services...

• Test the adequacy of your policies and procedures

  Policies and procedures need to reflect the levels of risk and capabilities of the organization. A...

Issue 3, March 1, 2004 - VIEW THE FULL ISSUE

• An eye on cardiac rehabilitation

  Make sure your hospital is compliant with Medicare's requirements for outpatient cardiac...

• Check it out

  You may think of background checks as a human resources (HR) function-a necessary step performed...

• Know the rules

  In the 2002 case Quinn v. Abiomed Inc., a man with a heart condition needed a heart replacement...

• The big three

  The Bush administration has touted the impact of the Medicare Prescription Drug Improvement and...

• Exclusion check policy

  Introduction: The Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public...

Issue 2, February 27, 2004 - VIEW THE FULL ISSUE

• Cardiac crackdown

  The Office of Inspector General (OIG) has placed coronary artery stent claims high on its list of...

• Policy: Toolkit helps MN hospital employees reduce identify theft

  Editor's note: The following is adapted from the employee toolkit for preventing identity theft at...

• Medicare reform bill lists fraud, abuse issues you need to know

  Most of the program integrity provisions in the new Medicare reform law, signed in December 2003...

• Enforcing security safeguards

  A worker from one St. Louis hospital opened 27 credit card accounts and ran up charges of $70,000...

• Just the facts

  At health care organizations, subpoenas often concern criminal issues and therefore come from...

• Ethics check: Keep conflicts of interest out of your facility

  Conflicts of interest have become a hot button issue for compliance officers. Why? Because...

Issue 1, January 5, 2004 - VIEW THE FULL ISSUE

• 2004's top compliance focus areas

  As you prioritize your compliance plan for 2004, consider where other professionals will devote...

• Resolve compliance hotline issues quickly to ensure effectiveness

  Hotline calls are among the simplest ways for your organization to identify compliance issues.

• Case study: Small provider finds ways to keep staff interested in HIPAA privacy

  In a small facility and a small community-where everyone knows everyone-it's a real challenge to...

• CMS issues interim guidance on EMTALA enforcement

  Off-campus, provider-based hospital departments are not obligated to meet the final regulations...