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Health Care Compliance Professional's Manual Health Care Compliance Professional's Manual

Health Care Compliance Professional's Manual

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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 is used by the Health Care Compliance Association (HCCA) as the basic text for its Compliance Academy - the program that prepares compliance professionals for the CHC (Certificate in Healthcare Compliance) certification exam.

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
Last Updated 11/20/2017
Product Line Wolters Kluwer Legal & Regulatory U.S.
ISBN 9780735570382
SKU 10046592-7777
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
    • Government Enforcement Trends
    • The Deficit Reduction Act of 2005: Significant Changes in Compliance Laws
  • Basics of the Law
    • A Brief History and Overview of Medicare
    • Medicare Prescription Drug Benefit
    • Billing and Coding Compliance
    • Health Care Fraud and Abuse Laws
    • False Claims Act and Qui Tam Suits
    • The 2008 – 2010 Implementation of the Deficit Reduction Act
    • Summary of State Civil False Claims Laws
    • Equal Employment and Labor Standards Laws
    • Worker Safety and Environmental Protection
    • An Overview of Federal Antitrust Laws and Enforcement Policies
    • Corporate Laws
    • Patient Record and Confidentiality Laws
    • 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
    • Choosing a Partner in Compliance: Advice for Compliance Professionals on the Healthcare Attorney-Client Relationship
    • Compliance and Governance for Health Care Organizations
    • Board Subcommittees
    • Medical Necessity and Quality of Care Issues for Compliance Officers
    • Clinical Laboratory Compliance: Current Issues and Risks
    • Cost Report Compliance
    • IRS Intermediate Sanctions
    • Basics of Research Compliance
    • Human Research Protections in Clinical Research
    • Managing Conflicts of Interest in Clinical Research
    • Research Misconduct and the Public Health Service
    • Clinical Research Billing and the National Coverage Decision
    • 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 Patient Protection and Affordable Care Act: Health Care System Overhaul
  • 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
    • Corporate Integrity Agreements and Certification of Compliance Agreements
    • Settlement Agreements With Corporate Integrity Provisions
    • CMS Program Integrity Group’s Compliance Initiatives
    • Mandatory Compliance: The New York Experience and Beyond
    • The Recovery Audit Contractor Program: What Compliance Officers Need to Know
  • Risk Assessment
    • Risk Assessment Basics for Compliance Officers
    • The Legal Risks of Conducting a Compliance Risk Assessment
    • Risk Assessment by Practice Area
  • Elements of Compliance Programs
    • Standards and Procedures: Codes of Conduct
    • Compliance Officers and Infrastructure
    • Hiring and Delegating Responsibility
    • Medical Staff Issues/Credentialing
    • Developing, Delivering, and Positioning Compliance Education and Training
    • Audits, Monitoring, and Self-Assessments
    • Hotlines and Other Reporting Mechanisms
    • Conducting an Internal Investigation
    • Voluntary Disclosure: The Benefits, Procedures, and Cautions to Consider
    • Discipline, Rewards, Evaluations, and Objective Settings
    • Compliance in Joint-Venture and Agency-Subcontractor Relationships
    • Document Creation, Retention, and Disposition
    • Legal and Business Risks of Compliance Programs
    • A Practical Approach to Developing a Compliance Program Manual
    • Evaluating and Improving a Compliance Program: A Resource for Health Care Board Members, Health Care Executives, and Compliance Officers
    • Caring for Our Uninsured Patients—Understanding and Meeting Our Compliance Obligations
    • Life Sciences Industries Compliance Overview
    • Charge Description Master (CDM) Compliance
  • 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
    • Available Tools and Resources
    • Evaluating the Compliance Officer
    • Interviewing Techniques for the Compliance Professional
    • The Structure of Optimal Compliance: Positioning the Compliance Department and the Management of its Human Capital
    • Compliance Professionals Working with Management: Influencing Change - Influencing Decision Making
    • Compliance Professionals Working with Physicians
    • Interacting with Pharmaceutical Representatives
    • How to Get Help from the Company Lawyer
    • Hospital Pharmacy Compliance: Protecting Patients from Medication Errors
    • Professional Liability Insurance for the Ethics and Compliance Professional
    • The Importance of Preadmission Screening for Inpatient Rehabilitation Services
    • Electronic Health Record Compliance Framework.
    • Delivery of Behavioral and Mental Health Services in the US: Funding, Legal and Regulatory Challenges
  • Model Policies and Forms
    • Auditing and Monitoring
    • Billing and Coding Compliance
    • Code of Conduct
    • Compliance Program, Development
    • Compliance Program, Evaluating and Improving
    • Conflict of Interest
    • Document Creation, Retention, and Disposition
    • HIPAA Privacy and Security
    • Hiring and Delegating Responsibility
    • Hotlines and Other Reporting Mechanisms
    • Internal Investigations
    • Interaction with Pharmaceutical Representatives