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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, 2005 - VIEW THE FULL ISSUE

• Expect patient backlash from Part D-related problems

  Hospitals must bill self-administered drugs to outpatients Hospital outpatient departments...

• Include ’lifetime reserve days’ on your list of audit priorities

  A patient lies in a hospital intensive care unit. Her coma has lasted for 85 days--nearly three...

• Prepare for effective compliance training

  Effective training is an important aspect of a successful compliance program. Before you begin...

• One hospital’s effort to restore confidence through a change in culture

  This spring, the former CEO of Vermont’s largest and only academic medical center stood...

Issue 11, November 1, 2005 - VIEW THE FULL ISSUE

• Go beyond the basics of pinpointing high-risk activities

  A risk assessment may be the most important project you undertake all year-and there's no one right...

• Sell HIPAA compliance: Spell out financial benefits

  In the business world, return on investment (ROI) is an important factor when determining whether...

• FAQs to help achieve cardiac rehab compliance

  Cardiac rehab rules have been a perennial feature of the OIG Work Plan and dozens of OIG audits...

Issue 10, October 1, 2005 - VIEW THE FULL ISSUE

• Attack denied claims with a team-oriented approach

  The number of claims denials in the gastrointestinal (GI) department at Roper St. Francis...

• Follow these five steps to establish audit logs that work

  HIPAA's security rule requires organizations to have audit controls, but there's still confusion...

• Seven steps for surviving your next external audit

  Checking and rechecking other people's work is part of being an auditor. But checking your own work...

• Verify patient care quality to ensure compliance

  Patient complaints can increase your facility's risk of being subject to in investigation. If you...

Issue 9, September 1, 2005 - VIEW THE FULL ISSUE

• Get ready: Cardiac rehab rules may soon change

  Cardiac rehabilitation has been the target of dozens of OIG investigations. But the rules governing...

• Get your facility started using smoking-cessation G codes

  In its latest quarterly outpatient prospective payment system update, CMS issued two new G codes...

• Audit outpatient cardiac rehab to verify compliance

  Outpatient cardiac rehab areas must have a physician stationed nearby at all times. On-call code...

• California to give fraud tipsters up to $1,000

  Smalltime whistleblowers who provide information about schemes to defraud California's healthcare...

Issue 8, August 1, 2005 - VIEW THE FULL ISSUE

• Experts say Scrushy verdict won't lessen SOX impact

  Last month, pundits predicted that the trial of HealthSouth founder Richard Scrushy would reveal...

• One hospital's media-relations solution to HIPAA

  For many hospitals, receiving phone calls from the press inquiring about a patient's condition is...

• Ensure that your board understands Sarbanes-Oxley

  Now more than ever, board members need to verify that their organizations meet compliance...

• Show the money in exclusive pathology contracts

  In the July SHCC, we discussed how the OIG's Supplemental Compliance Program Guidance for Hospitals...

• CMS guidance answers blood billing questions

  It's been five years in the making, so even with some inherent problems in CMS Transmittal 496...

Issue 7, July 1, 2005 - VIEW THE FULL ISSUE

• Have a plan for handling media in an unexpected event

  If you’re lucky, the only time your facility will ever deal with the media is when a local...

• Eleven tips to prevent errant inpatient admissions

  A patient reports to your hospital on a Saturday afternoon with lightheadedness and nausea. Your...

• OIG dissects pathology contract kickback issues

  Hospitals, labs, and pathologists have long struggled over compensation for managing and directing...

• Do a trial before offering patients passwords

  A patient-password system can improve privacy while allowing friends and relatives an easy way to...

Issue 6, June 1, 2005 - VIEW THE FULL ISSUE

• Online musings could spark investigation of your facility

  Hospital employees should watch what they reveal on the Internet Internet message boards, talk...

• CMS offers guidance for billing blood products under OPPS

  In a March transmittal, CMS offered help for hospitals and labs struggling with the rules for...

• Audit and review ED coding, billing, and reimbursement

  Given all the complexities of coding, billing, and associated reimbursement for emergency...

• Do patients recognize HIPAA violations at your facility?

  Part two of a two-part series. Although your facility probably has safeguards to protect...

Issue 5, May 1, 2005 - VIEW THE FULL ISSUE

• CMS-contracted auditors get a percentage of findings

  The government agency promises strong oversight of the RAC demonstration program Scrutinizing...

• Was that a HIPAA violation? Patient tales of provider slip-ups

  By now, HIPAA privacy and security compliance should be a reality at your facility. But perhaps you...

• Audit CVA procedures to receive proper payment

  During 2001 and again in 2003, insertion of a central venous access (CVA) device-regardless of...

• Prioritize risk assessments with these easy steps

  Review the OIG Work Plan, meet with external auditors, and stay up to date with local and national...

Issue 4, April 1, 2005 - VIEW THE FULL ISSUE

• Think like an investigator when prioritizing risk

  Government investigators consider many factors when deciding which organizations to target-but...

• Twelve quick tips for HIPAA security compliance

  As of mid-February, only 18% of providers were compliant with the HIPAA security rule, according to...

• Conduct more effective employee interviews

  Employee interviews must be handled delicately. The interviewer must be able to quickly establish a...

• Troubleshoot your hospital's stent procedures

  To keep up with one of the OIG's top priorities, verify that your hospital's cardiac stent...

Issue 3, March 1, 2005 - VIEW THE FULL ISSUE

• Compliance departments urged to maintain programs

  Experts say you should stay the course despite change in sentencing guidelines The U.S. Supreme...

• Stay alert about current regulatory trends-notably joint ventures

  With regulatory agencies considering ethical issues according to the ebb and flow of questions the...

• OIG publishes final draft of hospital program guidance

  The OIG on January 27 announced an update to its voluntary compliance program guidance for...

Issue 2, February 1, 2005 - VIEW THE FULL ISSUE

• Preparation, organization keys to surviving audits

  Until he started having to deal with Medicare and Medicaid laws in his various roles with the...

• Don't rely on electronic reviews to catch compliance issues

  Electronic reviews can identify holes in your coding that might merit a chargemaster addition or...

• 2005 Work Plan targets clinical research compliance

  According to the Department of Health and Human Services OIG's 2005 Work Plan-an annual outline of...

• Protect privilege to preserve investigation results

  Healthcare organizations that conduct internal investigations face two overriding needs: the need...

• Revenue cycle teams: Get paid what you're due

  Revenue cycle teams typically hone in on denials and look at lost revenues rather than assessing...

• Watch for three critical problems that can derail risk analysis

  Experienced project managers may already know that the potential for risk exists, and that some...

Issue 1, January 1, 2005 - VIEW THE FULL ISSUE

• Work Plan offers labs a menu of trouble spots

  Lab managers who want to keep up with possible OIG inquiries should check out the agency's 2005...

• HIPAA in the waiting room: Extend compliance to safeguard your facility

  Patient waiting rooms are an extension of physician practices, treatment centers, healthcare...

• Batten down the hatches against false claims suits

  According to the U.S. Department of Justice, federal officials recouped $2.1 billion in claims in...

• Falsified data pose problems that only you can sort out

  Although it's uncommon, data falsification occurs, says Robert Nicholas, JD, partner at the law...

• Centralized contracts save time, money, and hassle

  It's not every day that compliance officers get to use the words "simple" and "easy" to describe...

• Methodist Health System contract

  Methodist Health System contract

Issue 11, November 1, 2005

• Complicated observation rules may soon get easier

  Many providers feel that trying to qualify for the separately payable observation APC 0339, as...

• Regulators target quality-of-care to find false claims

  A Pennsylvania hospital has agreed to pay $200,000 to settle charges that employees used improper...