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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, 2006 - VIEW THE FULL ISSUE

• Prevent social engineers from accessing your facility's data

  Your organization probably wants a work force that is friendly, helpful, and builds goodwill with...

• CMS presents E/M guidelines for national consideration

  In the 2007 outpatient prospective payment system (OPPS) proposed rule, CMS states that the...

• Follow these 10 steps to ensure quality audit results

  It happens all too often: You start a seemingly simple audit of whether patient records include...

• What to consider when deciding whether to self-disclose

  Weighing the decision to self-disclose noncompliance to a fiscal intermediary (FI), carrier, law...

• Verify that your organization reports quality measures

  Hospitals are not required to report clinical quality measures to CMS, but failure to do so will...

Issue 11, November 1, 2006 - VIEW THE FULL ISSUE

• Avoid government scrutiny of executive compensation

  Are executives within your organization being showered with perks such as sports and theater...

• Time to transition to NPIs-take appropriate precautions for compliance

  The changeover from legacy numbers to national provider identifiers (NPI) is expected to make...

• Improve your nursing documentation by employing forms

  There are three types of forms that your organization can use to bolster nursing...

• OIG 2007 Work Plan to focus on false claims

  The Deficit Reduction Act of 2005 (DRA) is a prominent theme of the 2007 OIG Work Plan. The reason...

Issue 10, October 1, 2006 - VIEW THE FULL ISSUE

• DRA looming: Make sure that your organization is prepared

  The Deficit Reduction Act (DRA) takes effect three months from now, and when it comes to these...

• HIPAA training should focus on daily activities of staff to be effective

  All too often, HIPAA privacy training focuses on the regulation itself, but to truly be effective...

• Experts dispel some common coding misconceptions

  Myths persist over whether you can assign codes and evaluation and management (E/M) levels to...

Issue 9, September 1, 2006 - VIEW THE FULL ISSUE

• Tips to ensure effective training sessions

  One of the challenges of providing compliance educational sessions is to keep the topic interesting...

• Avoid sanctions by keeping electronic data for potential litigation

  Any organization might find itself involved in a legal dispute, regardless of its size or how well...

• How hospitalists can avoid common errors when billing for subsequent care

  As the physician who is always in, the hospitalist frequently bills Medicare and other payers for...

• Attorneys answer coders' questions about legal issues

  Editor's note: The following is a sample of questions and answers from a session held during the...

• Take these 10 steps to audit your compliance with cardiac rehab regulations

  When updating your facility for compliance with the changes to cardiac rehabilitation regulations...

Issue 8, August 1, 2006 - VIEW THE FULL ISSUE

• To root out risk areas, ask managers the right questions

  When conducting a risk assessment, one of the best ways to obtain information from your...

• Make HIPAA security a priority

  There's one thing that the HIPAA administrative simplification final enforcement rule, which...

• Change of diagnostic order? Make sure the claim is paid

  Hospital radiologists are considered as treating physicians and may order additional diagnostic...

• The six most common trends for liability

  Over the past 50 years, more states have held hospitals accountable and responsible for their role...

• Be a 'hospital Houdini' when auditing

  Hospital outpatient services, charges, and coding come from many sources-which can make auditing a...

Issue 7, July 1, 2006 - VIEW THE FULL ISSUE

• How much training does the Deficit Reduction Act require?

  Experts say clarification is needed on the DRA training requirement Many healthcare experts are...

• Go back to basics when securing remote access at your facility

  Conduct a risk assessment, train employees on policy Securing protected health information (PHI...

• Don't miss the new cardiac catheter reimbursements

  Cardiac catheterization is one of the more frequently reported current procedural terminology (CPT...

• Conduct inpatient coding audits to maintain compliance

  One of the most difficult and time-consuming tasks that a hospital undertakes is conducting...

• Ensure that your hotline meets a high standard

  Many facilities have hotlines that employees can use to report fraudulent practices and other...

• The DRA means that big changes are ahead for providers

  The Deficit Reduction Act (DRA) has major consequences for all providers of healthcare services and...

Issue 6, June 1, 2006 - VIEW THE FULL ISSUE

• Make quality of care a top priority at your organization

  Quality of care is a top priority for the U.S. Department of Health and Human Services (HHS), CMS...

• Avoid a HIPAA emergency in your organization's emergency department

  Although one of HIPAA's goals is to protect patient privacy, the regulations should never get in...

• Injections and infusions: Understand recent changes

  With 2006 drug administration current procedural terminology (CPT) and Healthcare Common Procedure...

• Ensure proper coding of these inpatient procedures

  Drug-eluting stent implantation, hip/knee revisions, PEJs, and use of tPA are among the most...

• There are risks involved when docs can't or won't treat specific patients

  What if a physician in your healthcare organization decides that he or she will no longer treat...

Issue 5, May 1, 2006 - VIEW THE FULL ISSUE

• Spice up your HIPAA training and target staff needs

  Tailor educational efforts to strengths, weaknesses A lot has changed since the Department of...

• Ensure employee policies outline whistleblower rights

  Does your facility's employee handbook include a detailed description of whistleblower protection...

• Inpatient, outpatient, or observation?

  Avoid denials with these strategies Consider the following scenario: A hospital transfers a...

• Develop a policy for responding to investigations

  Most healthcare organizations are prepared to respond to various critical incidents, including...

• Whistleblower ruling minimizes lab risk

  In an October 2005 court decision, U.S. ex rel. Whitten v. Triad Hospitals, Inc., a federal court...

• Audit your facility's physician E/M coding

  Evaluation and management (E/M) coding may no longer be on the OIG Work Plan, but that's no reason...

Issue 4, April 1, 2006 - VIEW THE FULL ISSUE

• Don’t let consultants lead you astray—diligence is critical

  In February, officials at Abraham Lincoln Memorial Hospital in Lincoln, IL, took the advice of a...

• Lead a new approach to admissions; improve accuracy and compliance

  Read three new models for reviewing patient status Chances are, your facility assigns patients...

• Comply with HIPAA when working with law enforcement

  Juggling law enforcement and HIPAA regulations can be tricky. The gray areas and confusing...

• Whistleblower must pay hospital’s legal costs for retaliatory firing claim

  A Federal judge in Michigan ruled that a whistleblower must pay $1.6 million in attorneys&rsquo...

• A guide to conducting solid internal investigations

  The day may come when a hotline call, routine claims review, or whistleblower’s complaint...

• Learn official guidelines for arterial stent placement

  The OIG recently released an audit report that showed how two providers inappropriately reported...

Issue 3, March 1, 2006 - VIEW THE FULL ISSUE

• Follow these four tips for effective preemption analysis

  State laws more stringent than HIPAA supersede the privacy and security regulations. But...

• Stay ahead of compliance officer double-duty

  Like many other healthcare organizations, laboratories might not have the resources to hire an...

• Tips to help solve the drug administration payer issue

  It is unlikely that private payers will recognize the new Medicare drug administration Healthcare...

Issue 2, February 1, 2006 - VIEW THE FULL ISSUE

• Avoid violating CIAs by ensuring that you have necessary staff and resources

  In December 2005, an OIG press release announced that Miami’s South Shore Hospitals and...

• Prioritize, document, and repeat to ensure BA compliance

  When you initiate or reexamine your relationship with a business associate (BA), keep in mind that...

• Giving IT tools to docs may defy anti-kickback rules

  Consider what might be wrong with the following scenario: A hospital provides a nonstaff physician...

• Free electronic health records? Not yet, but stay tuned

  New federal proposals grab industry attention; find out what they mean for your organization If you...

• Use these six tips to appeal non-Medicare denials

  Appealing denied claims is the specialty of Terri Rinker, MHA, reimbursement manager for Community...

Issue 1, January 1, 2006 - VIEW THE FULL ISSUE

• Medicare Part D is a major focus of the OIG Work Plan

  This year, OIG investigators plan to focus a lot of attention on Medicare Part D, according to the...

• Look beyond HIPAA when determining e-mail retention periods

  State laws, business practices also come into play E-mail can be an effective tool for...

• Audit cost reports for correct wage data

  Let’s face it: If you don’t have much experience looking at cost reports, the words...

• A seven-step approach to ongoing records review

  Avera McKennan Hospital and University Health Center in Sioux Falls, SD, had a system in place for...