| The AIS Guide to Medicare Compliance Risks & Strategies helps you stay current on the big-dollar topics of greatest concern to health care compliance professionals and anyone responsible for running a Medicare program.
In addition to the "usual" compliance issues related to billing, coding and documentation, plus Stark, HIPAA and FTC 'Red Flags,' the Obama administration is taking an aggressive stand against Medicare fraud, waste and abuse. And with health care reform taking center stage, legislators are looking to Medicare dollars as a possible source of funding – meaning increased scrutiny and enforcement actions.
Containing both overview and analysis – along with field-tested tools – The AIS Guide to Medicare Compliance Risks & Strategies can help you avoid problems before they occur. Its nine information-filled chapters cover everything from coding, billing, documentation and reimbursement, to Recovery Audit Contractors and OIG audits, as well as:
- ICD-10 implementation
- Payment for HACs and never-events
- Medical necessity
- Standing orders
- RAC high-risk areas
- Electronic health records
- Admissions procedures
- Gainsharing arrangements
- PHI
- And much, much more
Discover effective strategies developed by compliance officers from across the country, help reduce your compliance risks and strengthen your compliance program’s effectiveness. Order The AIS Guide to Medicare Compliance Risks & Strategies today!
Also Available on CD: For an additional $150, you can order the convenient CD version of The AIS Guide to Medicare Compliance Risks & Strategies. The CD contains all of the information in the print version and you’ll find what you need instantly with the user-friendly, searchable PDF format. Plus, all CD purchasers receive a free copy of the print version!
Table of Contents
Methodology
Chapter 1: Medicare Coding and Billing Issues
- Risk Areas
- Error Prevention
- ICD-10 Implementation Issues
Chapter 2: Payment and Reimbursement Issues
- Medical Necessity
- Observation Vs. Inpatient Admission
- Payment for Hospital Acquired Conditions (HACs), Never Events and Other Medical Errors
- Overpayments
- High-Dollar Cases
Chapter 3: Documentation
- Standing Orders
- Physician Signatures
- Physician Queries
- Documentation Clarity
- Diagnostic Testing
Chapter 4: Recovery Audit Contractors and Other Audit Areas
- Federal Guidelines for RACs
- Audit Strategies
- RAC High-Risk and Target Areas
Chapter 5: Compliance Processes and Administrative Strategies
- Admissions Procedures, Including EMTALA
- Gifts and Entertainment
- Case-Management Protocol
- Disclosure and Transparency
- Electronic Health Records
- Quality Initiatives
- Tools and Technology
- Training and Education
- Provider/ Pharmaceutical Relationships
- Attorney-Client Privilege
Chapter 6: Fraud and Abuse, False Claims
- False Claims Act
- Durable Medical Equipment Fraud and Abuse
- Federal Fraud Oversight and Legislative Efforts
- Judgments and Settlements
Chapter 7: Anti-Kickback and Stark Physician Self-Referral Laws
- Stark Federal Guidance
- Strategies for Complying With Stark
- Stark Violations and Enforcement
- Gainsharing Arrangements
- Anti-Kickback Statute
Chapter 8: OIG Audits and Settlements
* Audits
* Rulings, Opinions and Guidance
* Settlements and Recoveries
Chapter 9: Patient Privacy and Data Security
- Safeguarding Protected Health Information
- Patient Records Breaches
- EHRs and Other Data Security Issues
- Federal and State Laws and Regulations
- Security Breach Notification Laws
- FTC Red Flag Rule
- Other Enforcement Actions
- Identity Theft Breaches and Strategies
- Lawsuits, Settlements and Covered Entity
- HIPAA and Law Enforcement
- HIPAA’s Impact on Research
- Other Strategies for HIPAA Covered Entities
Appendix A: The Seven Elements of a Compliance Program
Appendix B: OIG Notice, Jan. 31, 2005, OIG Supplemental Compliance Program Guidance for Hospitals
Appendix C: OIG Notice, Feb. 23, 1998, Publication of the OIG Compliance Program Guidance for Hospitals
Master Table of Contents
Index of Charts |
