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

Health Care Compliance Professional's Manual, Third Edition

By Wolters Kluwer and the American Health Law Association
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The Health Care Compliance Professional's Manual  is one of the most vital, long-standing, and best known resources in the world of health care compliance. It has all the tools you and your compliance team need to plan and execute a customized compliance program. This new edition is filled with industry best practices, sample forms, policies, procedures, and much more to save you time and comply with federal standards.

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

  • Use OIG publications and Federal Sentencing Guidelines to plan and execute a customized compliance strategy that meets tough federal standards and minimizes enforcement risks
  • Oversee physician compensation and referrals
  • Perform risk assessments using matrixes with step-by-step instructions to pinpoint areas that pose compliance and operational risks
  • Draft compliance policies that form the foundation for a strong compliance program
  • Build a strong infrastructure reinforced by industry best practices
  • Create an effective education and training program that instills in employees the importance of legal compliance
  • Implement a privacy and security plan that ensures patient information is protected
  • Stay up-to-date on the latest legal and state and federal regulatory requirements affecting your facility, in areas such as HIPAA, EMTALA, fraud and abuse, reimbursement, privacy, security, patient safety, and clinical research
  • Study for CCB® Certification in Healthcare Compliance (CHC)

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

  • Practical coverage of federal and state laws governing your facility
  • Insight into helpful federal standards on effective compliance programs
  • Step-by-step guidance on implementing a sound compliance program
  • Examples of common risk areas and how to handle them
  • Time savings and peace of mind from sample policies, checklists and forms from members of the American Health Law Association (AHLA)

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

  • Learn how to apply auditing, monitoring, and self-assessment techniques for conducting internal investigations
  • 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, Second Edition ISBN: 9781543813265 SKU: 10071961-7777

Resources Sample Chapter(s)
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
    • Ethical Issues Between Compliance and Legal
    • Health Care Compliance Glossary
  • Basics of the Law
    • A Brief History and Overview of Medicare
    • A Brief Overview of the Medicaid Program
    • Medicare Prescription Drug Benefit
    • The 340B Drug Pricing Program
    • The Medicare Quality Payment Program: Transforming Health Care Delivery to Paying for Value
    • The Medicare Shared Savings Program: A Focus on Compliance
    • Cost Report Compliance
    • Billing and Coding Compliance
    • Medical Necessity Issues for Compliance Officers
    • Health Care Fraud and Abuse Laws
    • False Claims Act and Qui Tam Suits
    • Anti-kickback Statute Basics for Compliance Officers
    • The OIG's AKS Sprint Proposed Rule
    • A Compliance Officer's Guide to the Stark Law and Regulations
    • The 2019 Proposed Stark Rule Amendment/Part 1: Defining Fair Market Value, Compensation, and Commercially Reasonable
    • The 2019 Proposed Stark Rule Amendment/Part 2: Value-Based, EHR, and Other Exceptions
    • Legal Requirements Concerning Physician Compensation
    • The Federal Physician Payments Sunshine Act: Rules and Impact on Life Sciences Manufacturers, Physicians, and Teaching Hospitals
    • 2010-2014 Enforcing and Enhancing the Provisions of the Deficit Reduction Act of 2005
    • An Overview of Federal Antitrust Laws and Enforcement Policies
    • IRS Use of Intermediate Sanctions to Police Excess Benefit Transactions
    • Compliance and Governance for Health Care Organizations
    • HITECH Act—Meaningful Use of Electronic Health Records
    • A Compliance Officer's Guide to Complying with the HIPAA Privacy and Security Rules
    • Identity Theft Red Flags and Address Discrepancy Requirements
    • Emergency Medical Treatment and Active Labor Act
    • Caring for the Uninsured in the Age of the Affordable Care Act
    • Navigating the Evolving Marijuana Landscape
    • What is Clinical Research?
    • Clinical Research Regulations
    • The Clinical Trial Process
    • Institutional Review Boards (IRBs): The Basics
  • Compliance In Specific Health Care Settings
    • Clinical Laboratory Compliance: Current Issues and Risks
    • Federal and State Funding and Regulation of Behavioral Health Services
    • What Compliance Officers Need to Know to Develop and Maintain Effective Pharmacy Compliance Programs
    • Long-Term Care Facilities: Compliance Basics
    • A Compliance Officer’s Role in Oversight of Telehealth Programs and Issues that Might Arise
    • Compliance Oversight of Remote Patient Monitoring Programs
  • Compliance Forms And Practice Tools
    • Overview of Compliance Forms and Practice Tools
  • Who Sets the Standards of Compliance Programs?
    • Overview of the Office of Inspector General
    • The Federal Sentencing Guidelines: A Practical Overview
    • Meeting the Challenge of Corporate Integrity Agreements and Independent Review Organizations
    • CMS' Center for Program Integrity's Compliance Initiatives: Strategic Directions and Key Antifraud Activities
    • The Recovery Audit 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 Programs: The Role of Boards of Directors and Boards' Subcommittees
    • The Intersection of Credentialing and Compliance
    • Developing, Delivering, and Positioning Compliance Education and Training
    • 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 Departmental Audits
    • Hotlines and Compliance Communication
    • 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
    • Managing and Maintaining the Charge Description Master (CDM)
    • Developing an Effective Audit and Education Process to Improve Physician Revenue Integrity
    • 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
    • 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
    • Addressing Legal Risks in Health Care IT Contracts