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Professional
Compliance Previews |

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"The Associate" |
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This
video segment is taken from the HCCS "Fraud Awareness - Professional
Compliance" courseware. The issues presented in the
full-motion video are upcoding, downcoding, and incomplete
documentation. In the expanded version of this scene, we
discover that the associate is not documenting her services adequately,
and, as a consequence, the practice billing staff is prevented
from using higher codes that truly reflect the amount of work
she's doing. In effect, she's forcing the billing staff
to downcode her services. |
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"The
G-Man" |
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video segment is taken from the HCCS "Fraud
Awareness - Professional Compliance" courseware. The "Government
Man" video segments appear throughout
our courses whenever additional information
is available on how the government
may apply the law in specific situations
based on how they have done so in the
past. In this scene, the "Government
Man" discusses "Assumption
Billing", where some practitioners
limit the number of codes they use,
creating a potential pattern of fraud. |
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" The
Offer" |
This
video segment is taken from the HCCS "Fraud
Awareness - Professional Compliance" course. The
issue presented in the full-motion video is kickbacks. In
the expanded version of this scene, we
discover that the medical directorship
arrangement suggested by the administrator
in the scenario is improper because it
essentially provides payment in cash
or kind in exchange for patient referrals.
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Corporate
Compliance Previews |

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Billing and Reimbursement
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This
video segment is taken from the HCCS "Fraud
Awareness - Corporate Compliance" courseware.
The issue presented in the full-motion video relates to Billing
and Reimbursement. In the expanded version
of this scene, the coding staff are unable
to read the doctor's handwriting and
are left to guess at the diagnoses and DRG codes. What are the implications
of illegible handwriting in a patient's
chart relative to fraudulent billing?
How should the coding department handle
such instances? |
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EMTALA
(Anti-Dumping Regulations)
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This
video segment is taken from the HCCS "Fraud
Awareness - Corporate Compliance" courseware.
The issue presented in the full-motion video has to do with EMTALA
(the Emergency Medical Treatment and
Active Labor Act), also known as the
Anti-Dumping Statue. In the expanded
version of this scene, Dr. Lewis fully
examines the patient, stabilizes his
condition, notifies the patient that
better care can be given at another facility,
and then receives the patient's authorization
for transfer. Is Dr. Lewis justified
in transferring the patient? What are
her motivations? Is the transfer in any
way related to insurance payments?
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Patient Confidentiality |
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video segment is taken from the HCCS "Fraud
Awareness - Corporate Compliance" courseware.
The issue presented in the full-motion video is patient confidentiality.
In the expanded version of this scene,
Rich, a maintenance worker, inquires
about his supervisor at the hospital,
Nora, who has recently become a patient.
Rich has a genuine concern for his supervisor's
health, but does that give him the right
to know her medical condition? |
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Research
Compliance Previews |

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Grants and Contracts |
| This
video segment is taken from the HCCS "Research
Compliance: Grants and Contracts" courseware.
The issue presented in the full-motion video is patient confidentiality.
In the expanded version of this scene,
Dr. Orner, discusses with his supervisor,
a proposal that he submitted for a research
grant. His supervisor explains
why there are issues with his proposal
based upon government regulations. |
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Conflicts
of Interest and Scientific Misconduct |
| This
video segment is taken from the HCCS
"Research Compliance: Conflicts of
Interest and Scientific Misconduct"
courseware. The issue presented in the
full-motion video, Dr. Orner selects
a study participant that he hopes will
give his research study the specific
results needed to build a new research
center. |
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Human
Subjects |
| This
video segment is taken from the HCCS
"Research Compliance: Human Subjects"
courseware. In the issue presented in the
full-motion video, Dr. Orner tries convincing
Nancy that it would be to her benefit
if she participates in his drug study. |

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Quality Improvement Previews |

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Patient Safety |
| This
video segment is taken from the HCCS "Patient Safety" courseware.
In the issue presented in this full-motion video, hospital
administrators review with department
heads a new hospital initiative that will
improve Patient Safety throughout the
hospital. |
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Reducing Medication Errors |
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video segment is taken from the HCCS
"Reducing Medication Errors" courseware.
In the issue presented in this full-motion video, a nurse questions a
resident's order and then seeks out her
supervisor for advice and directions. |