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HCCS002 - Corporate Compliance

In today's environment, medical personnel cannot afford to take risks with lawsuits and other potentially devastating consequences that can be associated with failing to comply with internal standard operating procedures. Along with potentially costing millions of dollars, allegations of wrongdoing can damage an organization's reputation. Internal guidelines are set to protect healthcare providers from future lawsuits or penalties, meaning that healthcare and corporate compliance are inexorably linked and critical for an organization's continued success.

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Target Audience:

  • Directors/Trustees
  • Teaching Physicians
  • Resident Physicians
  • Community/Private Practice MD's
  • Non-Physician Providers
  • Clinical Staff
  • Administrators
  • Billing Staff
  • Non-Billing Staff

COURSE OUTLINE

  • INTRODUCTION
    • Explanation of possible repercussions
      • Loss of public trust, fines, penalties
    • The ethical basis for compliance
    • Key concepts from the OIG's "Corporate Responsibility and Corporate Compliance" Guidance for Board of Directors
  • COMPLIANCE RISK AREAS
    • Confidentiality of Patient Information
    • Documentation and Coding
    • Billing and Reimbursement
    • Illegal Provider Relationships
    • Anti-Dumping Regulations
    • Managed Care
    • Labor Laws
    • Conflicts of Interest
  • COMPLIANCE REVIEW
    • Health Care Administrator
    • Billing Manager
    • Coder
    • Emergency Room Physician
    • Housekeeping/Maintenance
  • ELEMENTS OF A COMPLIANCE PROGRAM
    • Overview of OIG Guidance
  • DOCUMENTATION AND CODING
    • Medical Necessity
    • Upcoding
    • Bundling/Unbundling
    • DRG Creep
    • PATH Requirements
    • Advanced Beneficiary Notification (ABN)
    • Medicare as Secondary Payer (MSPs)
    • Lab Services
    • Emergency Care Diagnosis Coding
    • Compliance Monitoring
  • BILLING AND REIMBURSEMENT
    • Billing for items and Services Not Rendered or Not Documented
    • 72 Hour Rule
    • Discharge in Lieu of Transfer
    • Duplicate Billing
    • Credit Balances
    • Cost Reports
    • Bad Debts
    • Ambulatory Payment Classifications (APCs)
  • OTHER RISK AREAS
    • Environmental Law
    • Research Compliance Issues
    • Marketing
    • Tax-exempt Status
    • Medical Records Creation/Retention
    • Long-Term-Care Hospital Payments
    • Consecutive Inpatient Stays
    • Outlier Payments
    • ER Diagnostic Tests
    • Cardiac Rehabilitation Services
    • Hospital Outpatient vs. Physician Coding
  • PATIENT CARE RISK AREAS
    • Medical Error Reduction
    • Restraint-related Deaths
    • Patient Safety Standards
    • Medicare's Hospital Quality Oversight Initiative
    • Medication Safety
    • Public Health Compliance Issues
    • Documentation and Quality Patient Care


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Health Care Compliance Strategies, Inc.
30 Jericho Executive Plaza · Suite 400c
Jericho, NY 11753-1098
(877) 933-4227

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