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

Health Care Compliance Professional's Manual

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 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 11/26/2018
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
  • 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
    • Health Care Fraud and Abuse Laws
    • False Claims Act and Qui Tam Suits
    • An Overview of Federal Antitrust Laws and Enforcement Policies
    • A Compliance Officer’s Guide to Complying with HIPAA Privacy and Security Rules
    • A Compliance Officer’s Guide to the Stark Law and Regulations
    • Clinical Laboratory Compliance: Current Issues and Risks
    • Cost Report Compliance
    • IRS Intermediate Sanctions
    • Basics of Research Compliance
    • Emergency Medical Treatment and Active Labor Act
    • Identity and the Red Flag and Address Discrepancy Requirements
  • 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
    • 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 and Governance for Health Care Organizations
    • Developing, Delivering, and Positioning Compliance Education and Training
    • The Intersection of Credentialing and Compliance
    • Audits, Monitoring, and Self-Assessments
    • 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
    • Record Retention Policies and Procedures for Health Care Organizations and Compliance Departments
    • 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
    • Managing and Maintaining the Charge Description Master (CDM)
    • The Compliance Officer’s Role in Establishing and Maintaining Cybersecurity
    • A Compliance Officer’s Role in Oversight of Telehealth Programs and Issues
  • The Compliance Professional
    • Thinking Like a Compliance Professional: A Code of Ethics for Health Care Compliance Professionals
    • 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
    • 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 for the Ethics and Compliance Professional
    • Delivery of Behavioral and Mental Health Services in the US: Funding, Legal and Regulatory Challenges