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HCCS001P - Professional Compliance - Physician Office
A course in the "General Compliance" Suite

Course Description

Compliance programs are now mandatory for physician practices. Government agencies are auditing physician offices and health plans are requiring providers to show proof that they have an effective compliance program that includes compliance training in place. Regulations increase and get more complex every year and it's critical that all staff know AND UNDERSTAND the rules to help protect your facility. An accusation of fraud can have serious consequences on the practice's financial status, patient care and reputation. Most fraud is inadvertent and can be avoided with proper knowledge of the rules.

The first step in maintaining an effective compliance program is to provide annual updated, expert compliance education to your physicians and staff members. This engaging, multimedia online course covers the rules and regulations that ALL physician office staff must follow to reduce fraud and abuse risks, improve the accuracy and completeness of billing and collections, and improve the quality of patient care.

This course is designed for medical staff, not for legal experts and contains video scenarios and exercises representing common compliance issues and resolutions. CME credits are available.

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Target Audience
  • Physicians
  • Billing Staff
  • Clinical Staff
  • Administrators
  • Non-Billing Staff
  • Transcriptionists
  • Coding and Billing Staff
  • Non-Physician Providers
  • Front and Back Office Staff
Course Outline


  • Common Types of Healthcare Fraud
    • Billing Fraud
    • Offering Gifts and Other Inducements to beneficiaries
    • Kickbacks and Self-referrals
    • Quackery
    • Pharmaceutical Fraud
    • OIG Work Plan Issues
  • Managed Care
    • Underutilization
    • Misrepresentation
    • Executive Compensation
  • Identity Theft
  • Patient Care (and the False Claims Act)
  • Physician Quality Reporting System (PQRS)
  • Recovery Auditors Program


  • Definition of "Pattern of Fraud"
  • Basic ICD-9
    • Background
    • Medical Necessity
    • Organization of Volumes
    • Use of ICD-9
  • ICD-10: It’s Coming
  • Basic CPT
    • Background of CPT
    • Bundle/Unbundled Codes
    • Medically Unlikely Services
    • Modifiers
    • Use of CPT
  • Basic Documentation Compliance
  • CMS Covered Preventive Services
  • Hospital Status Documentation
  • Incident-To-Services


  • Evaluation and Management Coding
    • Evaluation and Management Codes
    • Specialty Specific Issues
  • Physician Supervision of Diagnostic Tests
  • Medicare as Secondary Payer (MSP)
  • Advance Beneficiary Notice of Noncoverage (ABN)
  • Clinical Trial Services


  • What Do You Know?
  • Documenting E/M Services Using Either 1994/95 or 1997 Documentation Guidelines
  • Practical Hints


  • Potential Physician Documentation Problems
  • Upcoding
  • Downcoding


  • General Rules
  • Documentation by Students
  • Common Clinical Situations
  • Primary Care Center Exception
  • Time-Based Codes
  • Surgeries and Procedures
  • Teaching Setting Modifiers
  • Chief Residents/Fellows
  • Dr. Elder and Dr. Young


  • Background
    • Explanation of What Stark Law Addresses
  • Prohibited Referrals
    • List of Designated Health Services
  • Exceptions
  • Reporting and Sanctions
  • Definition of Anti-Kickback Statute
    • Regulatory and Statutory Safe Harbors
  • Self-Disclosure Guidelines

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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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