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Health Care Compliance Professional's Manual, Second Edition by Wolters Kluwer Editorial Staff Health Care Compliance Professional's Manual, Second Edition by Wolters Kluwer Editorial Staff

Health Care Compliance Professional's Manual, Second Edition

By Wolters Kluwer Editorial Staff
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The Health Care Compliance Professional's Manual gives you all the tools you need to plan and execute a customized compliance program that meets federal standards. It walks you through the entire process, start to finish, showing you how to draft compliance policies, build a strong compliance infrastructure in your organization, document your efforts, apply self-assessment techniques, create an effective education program, pinpoint areas of risk, conduct internal probes and much more.

The Health Care Compliance Professional's Manual will help you to:

  • Use OIG publications and Federal Sentencing Guidelines to help plan and execute a customized compliance strategy that meets tough federal standards
  • Perform risk assessment to pinpoint areas within your company that pose compliance and operational risks
  • Draft compliance policies that form the foundation for a strong compliance program
  • Build a strong infrastructure for compliance to work, including hiring the right personnel
  • Create an effective education and training program that instills in employees the value of legal compliance
  • Conduct internal probes that uncover legal violations before the federal government does - and mitigate possible penalties
  • Stay up-to-date on all the latest legal and regulatory requirements affecting your facility, including HIPAA, EMTALA, fraud and abuse reimbursement, privacy, security, patient safety and much more!

Packed with tools to make your job easier, The Health Care Compliance Professional's Manual will provide:

  • Practical coverage of federal and state laws governing your facility
  • Document efforts and apply self assessment techniques
  • Insight into helpful federal standards on effective compliance programs
  • Step-by-step guidance on implementing a sound compliance program
  • Time-saving sample compliance policies, forms, checklists, and chart

The Health Care Compliance Professional's Manual will protect your company if violations do occur:

  • Learn how to apply auditing, monitoring, and self-assessment techniques
  • Discover how to successfully follow the OIG's voluntary disclosure program to resolve overpayment problems and avoid exclusion from Medicare
  • Find out how to enter into a corporate integrity agreement to settle with the federal government and mitigate FCA-related penalties
  • Document your compliance efforts so you leave a protective paper trail that shields you from liability
  • And much more

Previous Edition: Health Care Compliance Professional's Manual ISBN: 9780735570382 SKU: 100046592-7777

Pages 1508
Last Updated 12/13/2019
Update Frequency Quarterly
Product Line Wolters Kluwer Legal & Regulatory U.S.
ISBN 9781543813265
SKU 10071961-7777
Publish Frequency Quarterly
Product Line Wolters Kluwer Legal & Regulatory U.S.
SKU 000000000010041601
Table of Contents
  • Introduction and Overview
    • Compliance, Health Care, and Organizations
    • The Compliance Officer in Context
  • Basics of the Law
    • A Brief History and Overview of Medicare
    • A Brief Overview of the Medicaid Program
    • Medicare Prescription Drug Benefit
    • Billing and Coding Compliance
    • The Medicare Quality Payment Program: Transforming Health Care Delivery to Paying for Value
    • Health Care Fraud and Abuse Laws
    • False Claims Act and Qui Tam Suits
    • 2010—2014 Enforcing and Enhancing the Provisions of the Deficit Reduction Act of 2005
    • An Overview of Federal Antitrust Laws and Enforcement Policies
    • HITECH Act—Meaningful Use of Electronic Health Records
    • A Compliance Officer’s Guide to Complying with HIPAA Privacy and Security Rules
    • Legal Requirements Concerning Physician Compensation
    • A Compliance Officer’s Guide to the Stark Law and Regulations
    • Medical Necessity Issues for Compliance Officers
    • The 340B Drug Pricing Program
    • Clinical Laboratory Compliance: Current Issues and Risks
    • Cost Report Compliance
    • IRS Use of Intermediate Sanctions to Police Excess Benefit Transactions
    • Human Research Protections in Clinical Research
    • Identification and Management of Financial Conflicts of Interests in Clinical Research
    • Research Misconduct and the Public Health Service
    • Clinical Research Billing and Medicare’s Clinical Trial Policy
    • Clinical Research Compliance and Physician Interaction with the Research Enterprise
    • Emergency Medical Treatment and Active Labor Act
    • Identity and the Red Flag and Address Discrepancy Requirements
    • The Medicare Shared Savings Program: A Focus on Compliance
    • The Federal Physician Payments Sunshine Act: The Rules and Impact on Life Sciences Manufacturers, Physicians, and Teaching Hospitals
    • Caring for the Uninsured in the Age of the Affordable Care Act
    • Navigating the Evolving Marijuana Landscape
  • Who Sets the Standards of Compliance Programs?
    • Overview of the Office of Inspector General
    • The Federal Sentencing Guidelines: A Practical Overview of Their Background, Intent, and Implications
    • Meeting the Challenge of Corporate Integrity Agreements and Independent Review Organizations
    • CMS Program Integrity Group’s Compliance Initiatives: A New Strategic Direction and Key Antifraud Activities
    • The Recovery Audit Contractor Program: What Compliance Officers Need to Know
  • Risk Assessment
    • Risk Assessment Basics for Compliance Officers
    • The Risk Assessment Matrix: Potential Compliance Risks and Responses
    • Internal Controls: Their Purpose and Role in Compliance
    • Addressing Improper Payments through Analytics and Data Mining
    • Enterprise Risk Management: What It Is and How It Benefits Health Care Providers
  • Elements of Compliance Programs
    • Standards and Procedures: Codes of Conduct
    • Compliance Officers and Infrastructure
    • Compliance and Governance for Health Care Organizations
    • Compliance Programs: The Role of Boards of Directors and Boards’ Subcommittees
    • Developing, Delivering, and Positioning Compliance Education and Training
    • The Intersection of Credentialing and Compliance
    • Screening for Excluded Parties
    • A Culture of Audit Readiness: How to Create One and Why It Is Important
    • Audits, Monitoring, and Self-Assessments
    • Creating or Enhancing Internal Department Audits
    • Hotlines and Other Reporting Mechanisms
    • Conducting an Internal Investigation
    • Self-Disclosure: The Benefits, Procedures, and Cautions to Consider
    • Using Incentives in Your Compliance and Ethics Program
    • Compliance in Joint Ventures and Physician Transactions
    • Record Retention Policies and Procedures for Health Care Organizations and Compliance Departments
    • Understanding and Navigating Health Care Industry Conflicts of Interest
    • Revenue Integrity: Partnering Across the Enterprise to Identify and Resolve Compliance Issues
    • Evaluating Compliance Program Effectiveness-Two Approaches
    • Evaluating and Improving a Compliance Program: A Resource for Health Care Board Members, Health Care Executives, and Compliance Officers
    • Managing and Maintaining the Charge Description Master (CDM)
    • Developing an Effective Audit and Education Process to Improve Physician Revenue Integrity
    • What Compliance Officers Need to Know to Develop and Maintain Effective Pharmacy Compliance Programs
    • A Practical Approach to Conducting “Stark” Audits of Hospital-Physician Arrangements
    • Privacy by Design: A Proactive Approach to Privacy Compliance
    • Prevention and Detection of Data Breaches
    • The Compliance Officer’s Role in Establishing and Maintaining Cybersecurity
    • Social Media Compliance in Health Care
    • Electronic Health Record Compliance Framework
    • A Compliance Officer’s Role in Oversight of Telehealth Programs and Issues that May Arise
    • The Compliance Professional’s Role in Mergers and Acquisitions
  • The Compliance Professional
    • Thinking Like a Compliance Professional: A Code of Ethics for Health Care Compliance Professionals
    • Integrating Ethics into a Compliance Program
    • When Professional Standards Conflict: Conflicts between Law, Ethics, and Self-Interest in Cases of Self-Disclosure
    • Evaluating the Compliance Officer
    • Interviewing Techniques for the Compliance Professional
    • The Varied Levels of Independence of a Chief Compliance Officer’s Role: Which is Right for You?
    • Compliance Professionals Influencing Up, Down, and Across the Organization
    • Compliance Professionals Working with Physicians
    • A Guide to Retaining Legal Counsel and the Consideration of Attorney-Client Relationship
    • Professional Liability Insurance: Protecting Compliance Professionals from Personal Liability in Legal Actions
    • Delivery of Behavioral and Mental Health Services in the US: Funding, Legal and Regulatory Challenges
    • Taking the Fear Out of Social Media: A Guide for Compliance Professionals
    • Addressing Legal Risks in Health Care IT Contracts