Compliance Resources - Compliance Articles - Operational Compliance
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11/09/2011 - Insurer's Efforts to Prevent Healthcare Fraud
The issue of fraud prevention has emerged with a new sense of urgency among administrators of public health insurance programs. In January 2010, the Department of Health and Human Services and Department of Justice launched a series of Regional Health Care Fraud Prevention Summits aimed at increasing awareness for health care fraud. In September 2010, a significant anti-fraud provision was signed into law by President Obama as a part of the Small Business Lending Act.
07/21/2011 - On Your Mark, Get Set…Not So Fast - Sorting out Possible effective Dates for PPACA Provisions
In a proposed rule that was published September 23, 2010, the Centers for Medicare and Medicaid Services (CMS) asked for comments from the healthcare community on proposed screening requirements (which include background checks) for providers and suppliers who enroll and participate in Medicare and Medicaid, and a compliance program requirement.
07/21/2011 - The Medicare Learning Network ®
Medicare providers and their billers often find themselves at a loss when it comes to keeping pace with the latest changes in Medicare policy. One place where you can have access to all Medicare educational information is The Medicare Learning Network® (MLN) – the home for official information for Medicare Fee-For-Service providers and their billing/coding staff.
06/06/2011 - HEAT Provider Compliance Training video available from the OIG
This material consists of 13 files including the PowerPoint slide presentation, a number of background papers, and a link to a video recording of Inspector General Levinson's keynote speech at the HCCA 15th Annual Compliance Institute.
02/08/2011 - Compliance in the Client-Billing Relationship
Compliance is defined as “being in accordance with a wish, request, demand or rule.” That covers a broad spectrum.
12/16/2010 - Adapting to the Future & Beware the Ice Age is Coming
President Obama’s healthcare technology stimulus plan, aka HITECH, calls for sharing of codified data between multiple practicing physicians. To help resolve this issue, AC Group has coined a new term — Integrated Community EHRs (ICE). ICE products are designed for community systems, including hospitals, MSOs, and IPAs where there is a desire to create one common community integrated patient record no matter where the patient is treated. A community based ICE solution includes three main components.
12/16/2010 - Billing Companies Can Advise Physicians on Medicare Pay Problems
The Sustainable Growth Rate (SGR) is a major part of the Medicare payment formula, threatening to devastate physician pay. To continue to meet their clients’ needs and maintain their own viability, savvy third-party medical billing companies must understand this issue and help their clients find ways to deal with it.
12/11/2009 - ICD-10-Operational Issues
12/11/2009 - How Ethical Are You?
05/28/2009 - Who Can You Trust With Your Electronic Claims
02/14/2009 - Help for Cardiology Clients
02/14/2009 - Focus on Risk-Operational Compliance
10/15/2008 - Building a Strong Compliance House
07/23/2008 - Beyond Compliance-Self Regulation
05/22/2008 - Is It Found Money?-Overpayments
05/22/2008 - Creating a Culture of Compliance
03/24/2008 - Tips from the Trenches-Compliance Advice
01/12/2008 - How to Navigate an Internal Investigation
01/11/2008 - Creating Your Business Contingency Plan
12/10/2007 - The Medicaid Integrity Plan Will Affect You and Your Clients
12/10/2007 - Credit Balance Processing & Escheat Laws
12/07/2007 - Montioring & Auditing-Risky Business
07/01/2007 - Securing the Company Jewels
06/10/2007 - A Compilation of Compliance Resources
07/10/2006 - Are You Doing It Without Knowing It?
05/10/2006 - Outside Chart Review-From a Different Angle
03/10/2006 - Should an Independent Expert Review Your Compliance Program?
01/10/2006 - The Agony of Starting Your Compliance Plan
09/07/2005 - Inspecting Your Compliance Program
03/10/2005 - Call From Medicare: Update Lost Information
12/10/2004 - Policy & Procedure Checklist for OIG Vulnerability
09/07/2003 - Compliance Pitfalls & Their Consequences
04/10/2003 - Billing-Business Lessons Learned in the Trenches
02/10/2003 - Client Stops Taking New Medicare Patients
01/07/2003 - Where Do I get Written Guidance on Compliance?
12/10/2002 - Unannounced Government Audit
12/10/2002 - Disaster Avoided with Operational Compliance Plan