A D V A N C E D T R A I N I N G S O L U T I O N S
A Closer Look at our Compliance Training Courses
includes scenarios, case studies, healthcare compliance examples, and course-ware testing.
Fraud & Abuse Level 1: General Staff
This module will provide a basic understanding of the Fraud and Abuse laws – the laws that protect health care programs like Medicare and Medicaid from paying claims that are fraudulent or wasteful. The course will address your reporting obligations if you suspect a fraud and abuse violation.
Fraud and Abuse Compliance Topics:
Fraud Key Points
Abuse Key Points
Reporting Fraud & Abuse
Key Points: Documentation
Key Points: Record Retention
Key Points: False Claims Act
Key Points: Anti-Kickback Statute
Key Points: Stark Law
Key Points: Reporting
Recommended Audience:, Nurses/Patient Care Providers, Laboratory, Physician Office Staff, Skilled Nursing/Long Term Care, Home Care, Hospice, Physicians-Employed, Information Systems, Therapies, Board Members, Radiology, Pharmacy, ER Staff, Dialysis, Cardiac Services
Fraud & Abuse Level 2: Intermediate
This course is divided into modules
Section 1: Value & Ethics
Section 2: Fraud & Abuse
Section 3: Conflict of Interest
Section 4: Enforcement, Agencies & Initiatives
Section 5: Compliance Programs
Section 6: Management Responsibilities
Upon completion of this course, you should be able to understand and describe: the importance of organizational values and ethics, the difference between fraud and abuse, the laws and regulations enacted to prevent fraud and abuse, a conflict of interest and how to manage it, your disclosures and reporting obligations, the state and federal enforcement agencies and initiatives, an effective compliance program, and your responsibilities as a member of management to the organization.
Section 1: Value and Ethics Compliance Topics:
Compliance responsibilities
Section 2: Fraud and Abuse Compliance Topics:
Types of Fraud
Prevention of Fraud
Abuse
Prevention of Abuse
Key Points: Fraud & Abuse
False Claims Act (FCA)
The Affordable Care Act of 2010 (ACA or Healthcare Reform)
State False Claims Acts
Key Points: False Claims Acts
Anti-Kickback Statute
Anti-Kickback Statute: Safe Harbors
Anti-Kickback Statute: Penalties
Stark Law
Stark Law: Penalties
Section 3: Conflict of Interest Compliance Topics:
Potential Conflict of Interest (COIs)
EMTALA
Key Points: EMTALA
Voluntary Refunds and Self-Disclosures
Voluntary Refunds and Self Disclosures: Potential Remedies
Employee Reporting of Regulatory Violations
Section 4: Enforcement Agencies & Initiatives Compliance Topics:
Enforcement Agencies
The Center for Medicare & Medicaid Services (CMS)
Office of Inspector General (OIG)
Office of Civil Rights (OCR)
US Department of Justice (DOJ)
State Medicaid OIG and Fraud Control Units
Health Care Fraud Prevention & Enforcement Action Team (“HEAT”)
Enforcement Initiatives: OIG Work Plan
“RAC”, “CERT”, “ZPICS” and “MIC’s”
Section 5: Compliance Programs Compliance Topics:
The Role of Compliance Program
Compliance Programs and OIG
Benefits of an Effective Compliance Program
Your Role in Compliance
Elements of an Effective Compliance Program:
Element 1: Policies & Procedures
Element 2: Oversight Responsibility and Governance
Element 3: Training & Education
Element 4: Lines of Communication
Element 5: Monitoring & Auditing
Element 6: Enforcement & Discipline
Element 7: Response & Prevention
Module 6: Management Responsibilities Compliance Topics:
Management Responsibilities & Duties
Recommended Audience: Management
Fraud & Abuse Level 3: Advanced
This course is divided into modules:
Section 1: Value & Ethics
Section 2: Fraud & Abuse
Section 3: Conflict of Interest
Section 4: Enforcement, Agencies & Initiatives
Section 5: High Risk Areas
Section 6: Compliance Programs
Upon completion of this course, you should be able to understand and describe: the importance of organizational values and ethics, the difference between fraud and abuse, the laws and regulations enacted to prevent fraud and abuse, a conflict of interest and how to manage it, your disclosures and reporting obligations, the state and federal enforcement agencies and initiatives, areas of high risk for fraud and abuse, an effective compliance program.
Section 1: Value and Ethics Compliance Topics:
Compliance values and ethics
Section 2: Fraud and Abuse Compliance Topics:
Types of Fraud
Prevention of Fraud
Abuse
Prevention of Abuse
Key Points: Fraud & Abuse
False Claims Act (FCA)
The Affordable Care Act of 2010 (ACA or Healthcare Reform)
Could a False Claim Exists
Billing for Services Not Provided
Billing for Services Not Documented in the Medical Record
Unbundling
Upcoding
Falsifying Statements
Failure to Refund Over-payments within 60 Days
Duplicate Billing
Admissions
Billing the Wrong Units for a Particular Medication
State False Claims Acts
Qui tam Provisions
Anti-Kickback Statute
Anti-Kickback Statute: Safe Harbors
Anti-Kickback Statute: Penalties
Stark Law
Stark Law: Penalties
Section 3: Conflict of Interest Compliance Topics:
Potential Conflict of Interest (COIs)
Voluntary Refunds or Self-Disclosures
Voluntary Refunds and Self Disclosures: Potential Remedies
Employee Reporting of Regulatory Violations
Section 4: Enforcement Agencies & Initiatives Compliance Topics:
Enforcement Agencies
The Center for Medicare & Medicaid Services (CMS)
Office of Inspector General (OIG)
Office of Civil Rights (OCR)
US Department of Justice (DOJ)
State Medicaid OIG and Fraud Control Units
Health Care Fraud Prevention & Enforcement Action Team (“HEAT”)
Enforcement Initiatives: OIG Work Plan
Enforcement Initiatives: RACs, CERT, ZPICs, MICs
Non-Governmental Payor Audit Initiatives
Section 5: High Risk Areas Compliance Topics:
Documentation
Documentation Requirements
Coding & Billing
Coding & Billing: Medical Necessity
Medicare Coverage Requirements
Finance
Section 6: Compliance Programs Compliance Topics:
The Role of a Compliance Program
Compliance Programs and OIG
Benefits of an Effective Compliance Program
Your Role in Compliance
Elements of An Effective Compliance Program:
Element 1: Policies & Procedures
Element 2: Oversight Responsibilities
Element 3: Training & Education
Element 4: Lines of Communication
Element 5: Monitoring & Auditing
Element 6: Enforcement & Discipline
Element 7: Response & Prevention
Effective Compliance Program
Recommended Audience: Coders, HIM, Coding Specialties, Billing/Financial Services, Admitting/Registration, Finance,
Patient Relationships and Compliance
This course will identify the components of good patient service, list and describe three important steps to take when responding to a patient complaint, describe the four pieces of information you need when contacting your supervisor about a patient complaint, describe four key benefits that can result from tracking patient complaints, and identify the proper steps for handling a patient complaint that is outside the scope of your job responsibilities.
Compliance Topics:
Providing Good Service
Handling Patient Complaints
Increasing Awareness of Recurring Issues
Resolving a Complaint
Complaints and Associated Risks
Recommended Audience: All Staff
Admissions & Registration 1: Collecting Patient Demographics
This course will provide you with specific information on collecting patient information at the time of admission and/or registration. By the end of the course you will be able to list the key steps involved in the patient registration process, name and describe the three categories of information that make up a patient’s demographic information, describe important insurance information you should obtain when registering a patient, explain why routine waiver of patient co-payments, co-insurance and deductibles could be a compliance issue, and identify at least two forms that may need to be completed during the patient registration process.
Compliance Topics:
Patient Registration Compliance
Collecting Patient Demographics
Collecting Patient Demographics-
Inaccurate Information
Obtaining Insurance Information
Contacting the Insurance Company
Co-Payments & Deductibles
Validating Medical Record Numbers
Financial Hardship & Waiver of
Co-payments/Deductibles
Medical Record Number-Compliance
and Monitoring
Registering Patients Receiving
Ancillary Services
Ancillary Services Registration-Additional
Forms
Identity Theft Protection Policy
Identifying Suspicious Activity
Detecting & Responding to Potential
Identity Theft
Recommended Audience: Coders, HIM, Billing/Patient Financial Services, Admitting, Registration, Laboratory, Skilled Nursing/Long Term Care, Home Care, Hospice, Finance, Physicians-Employed, Therapies, Radiology, Pharmacy, ER Staff, Dialysis, Cardiac Services
Admissions & Registration 2: ABNs and MSPs
This course discusses collecting additional patient information necessary for patient registration, while following the compliance requirements for your facility.
The course defines an Advance Beneficiary Notice (ABN) of Non-coverage, describes the minimum information that must be included on an ABN, identifies the types of services not covered by Medicare, explains when ABNs are not appropriate, identifies what the MSP questionnaire is and why it is used, and describes the patient and the facilities options if a patient refuses to sign an ABN.
Compliance Topics:
ABN Overview
ABN Requirements
ABN Forms
Other ABN Forms
Completing the ABN
Completed ABNs
Services Never Covered by Medicare
Notices of Exclusion from Medicare Benefits
Statutorily Excluded Services
Medically Unnecessary Services
Screening Services
Medicare as Secondary Payer (MSP)
MSP Compliance
Examples of Medicare as Secondary Payer
MSP Exceptions
When ABNs are Appropriate
ABN Scenarios
Obtaining ABNs in the Emergency Department
Obtaining Signatures
Patient Options
Patient Options-Choices
Patient Options-Exceptions
Recommended Audience: Coders, HIM, Billing/Patient Financial Services, Admitting, Registration, Laboratory, Skilled Nursing/Long Term Care, Home Care, Hospice, Finance, Physicians-Employed, Therapies, Radiology, Pharmacy, ER Staff, Dialysis, Cardiac Services
Admissions & Registration 3: Observation Services, HIPAA and Other Compliance RisksTime:
The course will define and provide an example of observation services, explain the difference between a regular and direct admission to observation, name and describe the three administrative simplification provisions included under HIPAA, list at least three situations that could result in a violation of patient confidentiality, explain why Medicare, Medicaid and third party payers are usually not considered the primary insurance for investigational and research procedures, define EMTALA and explains how this law can affect the registration process, explain why it is important to keep orders for patent services on file, and explain what a standing order is and what you can do if a standing order has expired.
Compliance Topics:
Observation Services
Observation Services-Exclusions
Registering Observation Services
Changing an Inpatient to Observation Services
Observation Services- Cases
Over 24 hours
Invalid Ordering/Referring Providers
HIPAA Overview
Notice of Observation
Invalid Ordering/Referring Providers
HIPAA’s Effect on Registration
HIPAA & Confidentiality
Other Compliance Risks
Investigational & Research Procedures & ABN
ER Patients/EMTALA
Definition of Emergency Department
Registration & EMTALA
Patient Orders
Standing Orders
Items to List on Standing Orders
Retention of Orders/Referrals
Invalid Ordering/Referring Providers
Handling Standing Orders that have Expired
Recommended Audience: Coders, HIM, Billing/Patient Financial Services, Admitting, Registration, Laboratory, Skilled Nursing/Long Term Care, Home Care, Hospice, Finance, Physicians-Employed, Therapies, Radiology, Pharmacy, ER Staff, Dialysis, Cardiac Services
Allied Health Services 1: Medical Necessity
This course will define medically necessary services, list the four key factors that support medical necessity for Medicare services, identify and describe the similarities and differences between National Coverage Determinations and Local Coverage Determinations, identify two ways diagnostic information may be submitted by healthcare providers, and describe the four diagnosis coding guidelines that can help prevent false claims.
Compliance Topics:
Establishing Medical Necessity
Medical Necessity
Medical Necessity Guidelines
National Coverage Determination
National Coverage Determination Examples
Local Coverage Determinations
Local Coverage Determination Examples
National & Local Coverage Determinations
Diagnosis Coding Confirmation
Diagnosis Coding
Requirements to Furnish Diagnostic Information
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
Allied Health Services 2: Covered and Non-Covered Services
This course will define an Advance Beneficiary Notice of Non-Coverage (ABN), describe the minimum information that must be included on an ABN, identify the types of items and services that are not covered by Medicare, explain when ABNs are not appropriate, identify what the MSP questionnaire is and why it is used, and describe patient and facility options if a patient refuses to sign an ABN.
Compliance Topics:
Advance Beneficiary Notices
Advance Beneficiary Notice Requirements
Non-covered Services
Screening Services
ABN Forms
Completing the ABN
Completed ABNs
Other ABN Forms
Services Never Covered by Medicare
Non-Covered Services
Screening Services
Medicare as Secondary Payer (MSP)
MSP Compliance
Examples of Medicare as Secondary Payer
MSP Exceptions
When ABNs are appropriate
ABN Scenarios
Obtaining ABNs in the Emergency Department
Obtaining Signatures
Patient Options
Patient Options-Choices
Patient Options-Exceptions
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
Allied Health Services 3: Processing Orders
Compliance is just as important to hospital reimbursement as coding and accounting. To obtain reimbursement for services, you will need to understand the regulatory requirements for processing different kinds of orders that may be received in your department. This course will identify an authorized provider, describe proper procedures and time frames for confirming verbal/telephone orders, describe the Medicare 3-Day (1-Day) Payment Window Policy and explain when outpatient services must be included in an inpatient stay based on the Rule, identify and describe the three main instances when charges may not accurately represent the services that were performed, describe the appropriate action to take when you receive an unclear order, and list the four key pieces of information you need to document when confirming an unclear order, and explain why orders/requests for tests must be kept on file.
Compliance Topics:
Processing Orders
Authorized Providers
Invalid Ordering/Referring Providers
Retention of Orders/Referrals
Verbal/Telephone Orders
Verbal/Telephone Orders-Timeframes
Three-day Outpatient Payment Window Rule
Services Ordered and Performed
Charge Capture Process
Unclear Orders
Unclear Orders-Documentation
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
Allied Health Services 4: Billing Compliance
This course will describe the difference between routine supplies and separately billable supplies, identify and describe potential violations of the False Claims Act and Anti-kickback Statute, such as unbundling, billing for routine supplies, duplicate billing and inconsistent charges and discounts, list four key changes that may require review of your Charge Description Master, and list four outcomes that could result from improper reporting of HCPCS codes.
Compliance Topics:
Billing Compliance-Overview
Separately Billable Supplies
Separately Billable Supplies-Ambulatory Payment Classification
Unbundling of Multiple Procedures
Duplicate Orders
Duplicate Orders-OIG Investigations
Charge Master Description
Changes to the Charge Master Description
The Department’s Role in HCPCS Code Assignment
Modifiers
Modifier-Examples
Investigational and Research Use Only Procedures
Consistency of Charges
Consistency of Charges-Examples
Discount Policies
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
Allied Health Services 5: Cardiology
This learning course will help you understand several basic concepts related to compliance and cardiac care. This course will define observation services and how they are reported, name two types of contrast materials used during certain radiology and imaging procedures and describe options for reporting these services, describe two specific problems that can lead to large differences in costs of cardiac catheterization services, describe proper billing procedures when submitting claims for electrophysiology services, define cardiac rehabilitation program services, and identify the two major criteria necessary when deciding if cardiac rehabilitation programs are reasonable and necessary.
Compliance Topics:
Observation Services
Observation: Physical Evaluation
Observation Services: Start/Stop Times
Payment for Observation Services
Reporting Observation Services
Treatment Room Charges
Contrast Materials
Charging for Contrast Materials
Cardiac Catheterization
Cardiac Catheterization: Documentation
Cardiac Catheterization: Injection Procedures
Electrophysiology
Electrophysiology: Coding & Documentation
Interventional Procedures
Cardiac Rehabilitation
Cardiac Rehabilitation: Participation
Coverage Conditions for Cardiac Rehabilitation
Notice of Observation
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
Allied Health Services 6: Dialysis
This learning course will help you understand several basic concepts related to compliance and dialysis services. This course will explain when a patient becomes eligible for Medicare ESRD benefits, identify when the ESRD Medical Evidence Report must be filed, identify QIP requirements for dialysis facilities, describe what a standing order is and how often it must be renewed for ESRD patients, explain what should happen if a patient is unavailable for all treatments during a month and describe the new bundled payment system for outpatient dialysis.
Compliance Topics:
Dialysis Services
ESRD Medicare Entitlement
Medicare Eligibility
ESRD Medical Evidence Report
ESRD Medical Evidence Report: Completion
ESRD Quality Initiatives Quality Reporting
ESRD Prospective Payment System (“PPS”)
Home Dialysis Payment Method
Home Dialysis Support Services
Partial Month Services
Epoetin Alfa and Darbepoetin Alfa
Renal Dialysis Services ESRD Drug Categories
ESRD Testing and the 50/50 Rule
Standing Orders
Items to List on Standing Orders
Handling Standing Orders that have Expired
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
Allied Health Services 7: Radiology
This learning module will help you understand several basic concepts related to compliance and radiology. This module will define the types of contrast materials and proper charge reporting contrast, provide an example of interventional radiology services and necessary billing procedures, differentiate between a diagnostic mammography and a screen mammography, describe proper billing of radiology services related to skilled nursing facility (SNF) patients, list necessary requirements for radiology students to perform procedures, list different ways to bill charges for radiology services, and describe when it is appropriate for a facility to bill set-up and transportation fees for x-rays performed with portable equipment.
Compliance Topics:
Contrast Material
Charging for Contrast Materials
Interventional Radiology
Interventional Radiology: S & I
Mammography
Mammography: Frequency of Screening Exams
Mammography: Charging for Services
Identifying and Charging Mammography Services
Skilled Nursing Facilities
Skilled Nursing Facilities: OIG
Skilled Nursing Facilities: Discounts
Education Programs
Education Programs: Oversight
Professional Fees
Professional Fees: Billing
Professional Fees: Compliance
Portable X-Ray Services
Portable X-Ray Services: Separate Billing
Radiology Services: Regulatory Updates
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
Allied Health Rehabilitative Therapies 8: Therapy Care
This learning module will Provide you with general information about how the regulatory environment and documentation affects payment for therapy services. This module will identify the different payment methodologies for therapy services, list three steps CMS takes to promote accurate payments to providers, describe two documents provided by the OIG and how they can be used by therapy providers to improve compliance, describe the difference between the plan of care, certification/re-certification, progress reports and treatment notes, explain when therapy treatment can begin, explain delayed certification and when it is acceptable, define durable medical equipment, explain when reporting a re-evaluation would be appropriate, and identify tools that are available to provide objective, measurable patient function information.
Compliance Topics:
Medicare Part A
Medicare Part B
Medical Necessity
Medicare & Medical Necessity
CMS
Office of Inspector General (OIG)
OIG Work Plan
Physician Certification/Re-Certification
Provider Roles
Certification
Re-certification
Durable Medical Equipment
DME & Certificate of Medical Necessity
Documentation Requirements
Initial Evaluation, Re-evaluation and Plan of Care
Skilled Therapy Maintenance Programs
Progress Reports
Progress Report Elements
Reasonable & Necessary: Skilled Therapy Maintenance
ProgramsTreatment Notes
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
Allied Health Rehabilitative Therapies 9: Coding & Billing
Proper coding and billing is one key compliance risk area identified by the Office of Inspector General (OIG) in the Compliance Program Guidance and annual Work Plans. This module will explain how NCCI edits are used to identify improper billing, describe the requirements for properly documenting and reporting a service based on time, describe the steps a therapist can take to verify charge accuracy, list two practices that can result in false claims, explain the requirements for properly reporting group therapy services, describe the difference between group therapy and providing individual care to multiple patients at the same time, define therapy caps and where they apply, explain the difference between general and direct supervision and how this applies to assistants, students and aides, and identify how services of assistants, students and aides are billed.
Compliance Topics:
Code Pair Edits
Time-based Therapy Services
Modifiers
Validating Charges
Pre-billing Audits
Group Therapy Services
Group Therapy Requirements
Individual vs. Group Therapy Services
Therapy Caps
Therapy Caps-Exceptions
Students, Assistants and Aides
Billing Services Provided by Students, Assistants and Aides
Supervision and Billing
Certification of Foreign Born Therapists
Other Therapy Billing Issues
Recommended Audience: Management, Billing/Patient Financial Services, Admitting, Registration, Physician Office Staff, Physicians-Employed
HIM Coding Compliance 1: General Coding Issues
This module will provide information regarding steps to take to promote proper coding in both the inpatient and outpatient setting. This module will define medical necessity, explain the difference between a statutorily excluded service and a medically unnecessary service, describe how medical necessity is identified, define up-coding, list the benefits of a physician query process, and list what a query form should and should not contain.
Compliance Topics:
Medical Necessity
Steps to Determine Medical Necessity
Statutorily Excluded Services
Medically Unnecessary Services
Screening Services
Medical Necessity Software
Up-coding
Physician Query Process
Query Format and Response
Recommended Audience: Coders, HIM, Coding Specialties
HIM Coding Compliance 2: Inpatient/Outpatient Coding
This module will provide information regarding steps to take to promote proper coding in both the inpatient and outpatient setting. The module will describe the difference between DRGs and MS-DRGs, list the three criteria established under the Uniform Hospital Discharge Data Set (UHDDS) for reporting inpatient services, describe why it is important to list discharge/transfer status codes on a claim and what can happen if the codes are improperly reported, identify the differences in code set(s) used to report inpatient and outpatient services, list two differences in reporting diagnoses between inpatient and outpatient services, and list four different ways HIM departments can improve outpatient documentation.
Compliance Topics:
Inpatient Coding
Inpatient Diagnoses Coding
Consequences of Improper Coding
Discharge/Transfer Status Codes
Discharge/Transfer MS-DRGs
Identifying Proper Discharge/Transfer Status Codes
Compliance and Discharge/Transfer Codes
Past OIG Findings Regarding Improper Discharges/Transfers
Problematic DRGs
Outpatient Procedure Coding & Examples
Outpatient Diagnosis Coding
Outpatient Diagnosis Coding-Applying ICD-9-CM Rules
Outpatient Diagnostic Guidelines
Outpatient Documentation Guidelines
Recommended Audience: Coders, HIM, Coding Specialties
HIM Coding Compliance 3: Coder Education and Ethics
This module will provide information regarding coder education and ethics. This module will explain the OIGs position on coder education, identify at least three additional topics outside of coding that coder training should address, list at least two OIG recommendations related to coder education and training, name two organizations that offer coding credentials, explain what can happen if a certified coder does not maintain the required number of continuing education hours, list at least four key points from AHIMA’s ethical standards for coding, identify the three coding references that must be updated at least annually, and describe how coding review/audits can be a part of the coder education process.
Compliance Topics:
OIG Requirements
Education Methods
Coder Training
Coding Credentials
AHIMA
AAPC
Ethical Standards & Examples
Government Resources
Coding Resources
Coder Feedback
AHIMA’s Standards for Ethical Coding
Recommended Audience: Coders, HIM, Coding Specialties
HIM Compliance Management 1: An Effective Compliance Program
This module will provide you with general information about the components of an effective compliance program including policies, procedures, and ongoing reviews necessary to promote complete, and accurate coding. This module will list and describe the seven elements of an effective compliance program, describe the responsibilities of the Compliance Officer in the facility, provide two examples of anonymous reporting mechanisms, name at least three topics that should be covered in department-level compliance training for HIM staff, and define what is meant by an individual who is “excluded from participation.”
Compliance Topics:
Effective Compliance Program: Overview
Element 1: Policies and Procedures
Policies and Procedures: Routine Reviews
Element 2: Oversight
Oversight: HIM Management Responsibilities
Element 3: Training and Education
Education Topics
Element 4: Communications
Anonymous Reporting Methods
Element 5: Disciplinary Policy and Action
Disciplinary Action and Employee Screening
Element 6: Auditing and Monitoring
Auditing and Monitoring Activities
Element 7: Problem Resolution and Corrective Actions
Developing Corrective Actions
Recommended Audience: Coders, HIM, Coding Specialties
HIM Compliance Management 2: HIM Compliance Policies
This module will provide you with general information about HIM compliance policies and procedures. This module will name three minimum documentation requirements recommended by the OIG Compliance Program Guidance for Hospitals, define the Uniform Hospital Discharge Data Set (UHDDS), define the charge description master, name two sources that provide diagnostic coding guidance, list the four cooperating parties that help develop the official ICD-9-CM coding guidelines, and describe an inappropriate financial incentive that might be offered to coders or contractors.
Compliance Topics:
Documentation: Policies & Procedures
Documentation: Minimum Requirements
Documentation: Code Assignment
Quality Improvement Organizations
Proper Selection and Sequencing of Diagnosis
Official ICD-9-CM/ICD-10-CM Coding Guidelines
Coding Guidelines
ICD-10-CM Coding
Coding Resources
Professional Organizational Agencies
Chargemaster: Coordination
Chargemaster: Updates
Chargemaster Updates: Coordination
Coder Incentives
Appropriate Coding Incentives
Service Contracts
Service Contracts: Contractor Incentives
Recommended Audience: Coders, HIM, Coding Specialties
HIM Compliance Management 3: Coding Quality Reviews
This module will provide you with general information about HIM auditing and monitoring activities. This module will explain the difference between internal and external reviews, describing the benefits of each method, describe the key differences between pre-billing quality reviews and retrospective reviews, explain the difference between re-bills and refunds to Medicare, define random sampling and list two methods of random sampling, explain the main benefit of focused sampling, and define the Program for Evaluating Payment Patterns Electronic Reporting (PEPPER).
Compliance Topics:
Coding Quality Reviews
Internal Reviews
External Reviews
Pre-billing Reviews
Rebilling Policies
Tracking Rebilled Claims
Random vs. Focused Samples
Random Selection of Records
Focused Selection of Records
Audit Trends
Audit Trends: Benefits
Comparative Statistics
Analyzing Trends: Case Mix
OIG Work Plan
PEPPER
PEPPER Uses
PEPPER Data and Outliers
PEPPER Focused Audits
Reporting Quality Review Activities
Coding Error Patterns
National Correct Coding Initiative
CCI: Examples
Recommended Audience: Coders, HIM, Coding Specialties
HIM General Compliance 1: Regulatory Environment
This module will give you an overview of the regulatory environment to Health Information Management services. This module will list five requirements of the Conditions of Participation for Hospitals, identify five organizations or agencies that offer facility accreditation, list three areas where HIM can affect accreditation surveys, name four items addressed by HIPAA, and describe the documentation requirements for teaching physicians.
Compliance Topics:
Regulatory Environment
Federal Agencies
Conditions of Participation
Conditions of Participation Updates
Quality Assessment Performance Improvement
State Agencies
Voluntary Accreditation Programs
The Joint Commission Accreditation Manual for Hospitals
HIM and Accreditation
HIPAA
HIPAA and Confidentiality
Balanced Budget Act of 1997
Recovery Audit Program
Physicians at Teaching Hospitals (PATH) Audits
Teaching Physician Documentation
Electronic Signature Requirements
Recommended Audience: Coders, HIM, Specialties
HIM General Compliance 2: HIM Practice Implications
This module will provide an example of how requirements may differ between CMS, the Joint Commission and your facility policies and procedures and identify which requirement you should follow, list three Joint Commission requirements that are challenging for HIM professionals, describe delinquent record compliance criteria, explain what the National Patient Safety Goals are and when they are updated, describe when authorization is required to release patient information, explain the difference between confidential and non-confidential information, and describe the process to correct an error in a paper based and computer based patient record.
Compliance Topics:
Practice Implications
Differences in Requirements
Joint Commission Challenging Areas
Ambulatory Summary Lists
Medical Record Review
Delinquent Records
Delinquent Records Levels of Compliance
Joint Commission Updates
Unannounced Inspections
Patient Safety Goals
Tracer Methodology
Health Information
Confidentiality
Release of Information
Release of Information-Special Circumstances
Late Entries, Addenda and Correction to the Medical Record
Patient Requested Amendments
Duplicate/Overlay Medical Record Numbers
Medical Record Number Monitoring
Recommended Audience: Coders, HIM, Specialties
Nursing Documentation 1: Medical Necessity, Forms, and ABNs
This course will provide you with general knowledge about the rules and regulations affecting nursing providers today. The course will identify the various forms used in healthcare settings, describe two situations when an Advance Beneficiary Notice would be appropriate, explain why it is improper to provide an ABN to all patients for every service procedure that is performed and define medical necessity.
Compliance Topics:
Medical Necessity
Medical Necessity-Requirements
Guidelines
Forms, Consents & Directives
Advance Beneficiary Notice (ABN)
When ABNs are Appropriate
Medicare Guidelines
Non-Covered Services
Screening Services
Obtaining Signatures
Patient Refusals
Types of ABN Forms
Completing the ABN
Obtaining ABNs in the ER
Recommended Audience: Nurses/Patient Care Services, Skilled Nursing/Long Term Care, Home Care, Discharge Planning, Hospice, Therapies
Nursing Documentation 2: Documentation & Orders
This course will list four uses of the medical record, describe how to make appropriate late entries and corrections to the medical record, describe the consequences of inappropriate or inaccurate documentation, and identify what you should do if a valid order is not documented in the medical record.
Compliance Topics:
General Principles of Documentation
Primary Use of the Medical Record
Abbreviations
Authentication of Entries
Late Entries
Late Entries-Paper and Electronic Medical Records
HIPAA-Changes to the Medical Record
OIG Documentation Requirements
Other Important Documentation
Post Payment Documentation Reviews
Consequences of Incomplete/Inaccurate/Documentation
Verbal/Telephone Orders
Verbal Orders
Verbal Order Requirements
Verification of Physician Orders
Services Without Orders
Recommended Audience: Nurses/Patient Care Services, Skilled Nursing/Long Term Care, Home Care, Discharge Planning, Hospice, Therapies
Nursing Documentation 3: Rules, Regulations, Laws and Statutes
This module will provide you with general information about the regulatory environment affecting healthcare providers today. This module will describe the Health Insurance Portability and Accountability Act (HIPAA) and provide examples of potential violations, identify why confidentiality is important and list three areas where specific confidentiality requirements apply, explain the Stark Laws and Anti-kickback Statute and describe potential violations, describe how releasing patient information if affected by specific conditions including treatment for alcohol or drug dependency, HIV/AIDs and court orders, explain what you must do when providing a referral for post-acute care to patients, and define EMTALA and how it affects nursing services.
Compliance Topics:
Principles of Medical Record Documentation-Overview
HIPAA and Confidentiality
Protected Health Information (PHI)
Medical Records
Authorizations
Confidentiality & Release of Information
Review of Stark Laws & Anti-Kickback Statute
Stark Laws Overview
Exceptions to the Stark Laws
Anti-Kickback Statute
Vendor Gifts and the Anti-Kickback Statute
Patient Gifts and the Anti-Kickback Statute
Related Entities and Freedom of Choice
EMTALA Overview
EMTALA Registration
Recommended Audience: Nurses/Patient Care Services, Skilled Nursing/Long Term Care, Home Care, Discharge Planning, Hospice, Therapies
Nursing Documentation 4: Other Compliance Topics
This module will identify the importance of the ongoing assessment, explain the requirements for observation services, explain what the Three-Day Rule is and how it affects billing for inpatient admissions, describe how to handle unused medication, and identify some of the services that can be performed by non-nursing personnel.
Compliance Topics:
Ongoing Assessment-Medical Necessity
Ongoing Assessment-Timely Communication
Outpatient Observation Services
Documenting Observation Services
Observation Orders/Cases Exclusions
Observation: Physical Evaluation
Admitting a Patient from Observation
Observation Services vs. Admission
Observation Services
Changing Observation Status
Observation Services: Start/Stop Times
Reporting Observation Services
Observation Time Over 24 Hours
Improper Admission from Observation
Payment for Observation Services
Why is the Admission Status Such an Important Decision
The 2-Midnight Rule
Three-Day Outpatient Payment Window Rule
Three-Day Outpatient Payment Window-Exceptions
Unused Medication-Overview
Services Provided by Non-Nursing Personnel-Overview
Recommended Audience: Nurses/Patient Care Services, Skilled Nursing/Long Term Care, Home Care, Discharge Planning, Hospice, Therapies
Skilled Nursing 1: Three-Day Prior Hospitalization
The risks of non-compliance with existing requirements will be identified throughout the courses with specific rules, regulations and requirements cited.
Some of the laws, rules and guidelines pertaining to skilled nursing and covered in these courses include: Medicare Part A and Part B, Balanced Budget Act of 1997-Prospective Payment System, OIG Compliance Program Guidance for Nursing Facilities, the Omnibus Reconciliation Act of 1987, Anti-kickback Statute and the Stark Physician Self-Referral Law, the Patient Protection and Affordable Care Act (PPACA) and the American Taxpayer Act of 2012.
Compliance Topics:
Review of Regulatory Requirements
Verification of Compliance
Consequences of Non-Compliance
Recommended Audience: Skilled Nursing/Long Term Care, Discharge Planning, Hospice, Physicians-Employed
Skilled Nursing 2: Medical Necessity & Utilization Review
Compliance Topics:
What is Necessary for Coverage in a SNF
Skilled Nursing Services
Skilled Rehabilitation Services
Verification of Benefits/MSP/Assignment of Benefits
Physician Certification/Re-certification
Recommended Audience: Skilled Nursing/Long Term Care, Discharge Planning, Hospice, Physicians-Employed
Skilled Nursing 3: MDS, Billing and Reimbursement
Compliance Topics:
Review of Regulatory Requirements
MDS as a Reimbursement Tool
MDS and its Relation to Billing
Change of Condition
Co-payments & Deductibles
Consolidated Billing
Recommended Audience: Skilled Nursing/Long Term Care, Discharge Planning, Hospice, Physicians-Employed
Skilled Nursing 4: Patient Care Issues
Compliance Topics:
Quality of Care-OIG Guidelines
Residents Rights
Ongoing Assessment
Recommended Audience: Skilled Nursing/Long Term Care, Discharge Planning, Hospice, Physicians-Employed
Skilled Nursing 5: Other Compliance Issues
Compliance Topics:
Documentation
Referral Relationships
Hospice & Skilled Nursing
Medicare Part D
Recommended Audience: Skilled Nursing/Long Term Care, Discharge Planning, Hospice, Physicians-Employed
Patient Financial Services 1: General Compliance
This course will provide you with general information about how the regulatory environment affects a facility’s ability to receive payment for services. This course will define medically necessary services, identify the types of services that are not covered by Medicare, describe the purpose of an Advance Beneficiary Notice of Non-coverage (ABN), list the five pieces of information, at minimum, included on an ABN, provide two examples when the use of an ABN is not appropriate, and describe different patient and facility options if a patient refuses to sign an ABN.
Compliance Topics:
Medical Necessity
Non-Covered Services
Statutorily Excluded Services
Medically Unnecessary Services
Obtaining ABNs in the ER
Non-Covered Services: ABNs & HINNs
Screening Services
Patient Options
ABN Forms
When ABNs are Appropriate
Patient Options: Exceptions
Facility Options: Choices
Examples of Medical Unnecessary Services
Advanced Beneficiary Notices (ABNs)
Promoting Compliance with Medical Necessity Guidelines
Advanced Beneficiary Notices and PFS
Advanced Beneficiary Notice Requirements
Other Financial Responsibility Forms
Recommended Audience: Billing/Patient Financial Services
Patient Financial Services 2: Claims Processing
This module will provide you with information about how the regulatory environment affects a facility’s ability to process claims and receive payment for services. This module will explain why a Medicare Secondary Payer questionnaire is needed, describe the Three-day Outpatient Payment Window Rule, define the Charge Description Master and describe at least two important items on your facility’s CDM that should be reviewed at least annually, define observation services and describe the conditions necessary to receive reimbursement from Medicare, and name at least two types of services that are NOT included in the composite rate payment calculation used for End Stage Renal Disease services.
Compliance Topics:
Medicare as Secondary Payer (MSP)
MSP Compliance
MSP Exceptions
Discharge/Transfer
Discharge/Transfer Compliance
Charge Description Master
CDM Updates
Unbundling/Examples
Observation Services
Observation: Physician Evaluation
Observation Services: Start/Stop Times
Payment for Observation Services
Reporting Observation Services
Observation Orders
3-Day (or 1-Day) Payment Window Rule
Changing Inpatient Status to Observation
End Stage Renal Disease
Investigational & Research Procedures
Exceptions: Clinical Trial Services
Ambulance Services
Ambulance Services: Medical Necessity
HIPAA
Notice of Observation
Recommended Audience: Billing/Patient Financial Services
Patient Financial Services 3: Claims Submission
To receive reimbursement from Medicare, the facility must submit a claim with the appropriate information. Prior to submission of the claim, it is necessary to review and edit the claim to verify the information listed is complete and accurate.
This module identifies at least three different systems that can affect claims, list two reasons why claims are held, explains how late charges are submitted for compliant billing, names at least three major categories of information found on the UB-04 claim form, defines the National Provider identification number and explain when it is used, describes the two types of duplicate charges and gives an example of each, explains what a “Return-to-Provider” report is and why it should be reviewed, and describes the difference between “re-billing” and “re-submission” of claims.
Compliance Topics:
Systems Integrity
Implementation on the NPI
Claims Editing
Holding Claims
Late Charges
Claims Editing: UB-04 Form
Claims Editing: Policies & Procedures
Duplicate Charges
Duplicate Claims
Duplicate Orders- OIG Investigation
Return to Provider Reports
Re-billing/Re-submission
Electronic Claims
Electronic Billing Integrity & Examples
Recommended Audience: Billing/Patient Financial Services
Patient Financial Services 4: Payments & Refunds
After the claim has been submitted to the payer, the next step in the process relates to payment and denials for those services.
This module describes the difference between contractual adjustments, write-offs
and credit balances and gives examples of each, explains why it is important to have a Denials Management program in place and communicate this information with other departments, explains the process of reporting credit balances to Medicare, names at least three criteria that must be met before assigning non-collectible accounts to bad debt, describes what APCs are and list at least three items that must be present on the claim to determine the APC for services provided to the patient, and describes the cost report and explains the connection between accurate patient claims and the cost report.
Compliance Topics:
Contractual Adjustments & Allowances
Contractual Adjustments- Patient Billing
Denials
Communication of Errors
Appeals
Duplicate Charges
Medicare Credit Balance Reporting
Credit Balances-Policies & Procedures
Bad Debt
Processing Bad Debt
Write-Offs & Examples
Administrative Write-Offs
Waiver of Coinsurance & Deductibles
Write-Offs and Compliance
Adjustments-Documentation
Charity/Free Care
APC Reimbursement
Determining APC Payment Amounts
Cost Report-Overview
Cost Report-Implications
Causes of an Inaccurate Cost Report
Repayment of Overpayments
Recommended Audience: Billing/Patient Financial Services
Laboratory Administration 1: CLIA Certification
This course will provide you with an overview of CLIA certificates, what they are, and the requirements to maintain certification. This course will identify and describe the different types of laboratory tests, list three exceptions where a separate CLIA certificate is not required, list the types of CLIA certificates and describe each, identify three of the six approved accrediting agencies, list five changes in the laboratory that require notification to CMS, explain what CLIA exempt means, identify the successful completion requirements for proficiency testing, describe three criteria that must be followed when performing proficiency testing, identify the penalty for sending proficiency testing specimens to another laboratory, and identify how often laboratories are inspected, including laboratories that qualify for the Alternate Quality Assessment Survey (AQAS).
Compliance Topics:
Types of Laboratory Testing
Waived Testing
Non-Waived Testing
Who Needs a CLIA Certificate
Types of CLIA Certificates
Application for Certification
CLIA Exemption
Maintaining a CLIA Certificate
Proficiency Testing
Proficiency Testing Requirements
Inspection Process
Testing Locations
CLIA and Billing Laboratory Tests
Exceptions
Recommended Audience: Laboratory, Physicians-Employed
Laboratory Administration 2: Laboratory Compliance Issues
In the laboratory, there are many different tasks that must be performed to promote efficient operations. Many of these tasks can also affect compliance. This module will describe at least three things you can do when designing a requisition to meet the OIG’s recommendations, explain three methods you can use to educate physicians on how to properly order laboratory tests, explain why it is important to provide annual notices to physicians, list at least four items that should be included in the annual notice, explain two methods the laboratory can use to monitor test utilization, identify the law that may be violated if physicians use equipment and supplies provided by the laboratory for their own use.
Compliance Topics:
Requisition Design
OIG Recommendations for Requisitions
Notice to Physicians
Ordering Tests Not Listed on the Requisition
Test Utilization & Monitoring
Reasons for Change in Test Volume
Provisions of Equipment and Supplies
Duties for “On-Site” Laboratory Employees
Other Opportunities to Communicate
Recommended Audience: Laboratory, Physicians-Employed
Laboratory Administration 3: General Compliance Issues
This module will describe the Stark Law and how it can affect billing for laboratory tests, explain how the laboratory’s record retention policies should be established in relation to regulatory guidelines as well as the facility’s global policy, list at least five specific documents the laboratory should retain for ordered tests and services, describe when a direct treatment relationship may exist in the laboratory, define what an outreach program is and list four areas that need to be addressed when setting up an outreach program, explain why it is important for laboratories to review denial reports, and list at least three different laws that are often applied during laboratory investigations.
Compliance Topics:
Stark Law & Exceptions
Record Retention
Record Retention and Compliance
Negotiated Rulemaking Standards
Contacting Physicians for Information
HIPAA Overview
Confidentiality in the Laboratory
Direct vs. Indirect Treatment Relationship
Laboratory Outreach Programs
Regulatory Updates
Regulatory Considerations for Outreach Programs
Denials, Non-Payments and Appeals
Applicable Laws
Recommended Audience: Laboratory, Physicians-Employed
Laboratory Coding & Pricing 1: Coding, Pricing and the CDM
This module will provide an overview of how HCPCS codes and modifiers are linked to tests in the Charge Description Master (CDM). This module will define HCPCS codes and modifiers, identify the criteria used to assign HCPCS codes for laboratory tests and services, explain the hierarchy for HCPCS code assignment, explain modifier -59 and -91 and provide an example of when each would be used, list three criteria that should be addressed when pricing laboratory services, identify two state regulations that could affect pricing for laboratory services, describe what the Charge Description Master (CDM) is and why it needs to be updated, and list at least three changes in the laboratory that could affect the CDM.
Compliance Topics:
HCPCS Codes
HCPCS Code Assignment
Revenue Codes
HCPCS & Screening Tests
HCPCS Code assignment and the Laboratory
Ad Hoc Updates
Pricing Overview
Modifiers
State Pricing Requirements
Chargemaster Review
Charge Description Master
Documenting Updates
Recommended Audience: Laboratory, Physicians-Employed
Laboratory Coding & Pricing 2: Special Coding Situations
In most cases, coding and pricing of laboratory tests can be fairly straightforward as long as specific steps are taken to verify the codes selected are appropriate. There are some situations where the right choice is not as clear. This module will explain how Organ and Disease Oriented panels should be billed, explain the Office of Inspector General’s position on offering custom panels and profiles, describe steps laboratories should take if they choose to offer custom panels and profiles, explain any pricing concerns related to panels and profiles, define miscellaneous tests and the information needed to properly bill and report these services, explain the difference between Research Use Only (RUO) tests and testing performed for clinical trials, list billing considerations for RUO tests and clinical trials.
Compliance Topics:
Organ & Disease Oriented Panels
Organ/Disease Panels & ESRD Testing
Custom Panels & Profiles
OIG Recommendations for Custom Profiles
Creating Custom Panels/Profiles
Panel Pricing
Miscellaneous Tests
Identification & Entry of Miscellaneous Tests
Reporting/Billing of Miscellaneous Tests
Miscellaneous In-House Tests
RUO/IUO Tests
Reporting RUO/IUO Tests
Billing RUO/IUO Tests
Recommended Audience: Laboratory, Physicians-Employed
Processing Laboratory Orders 1: Registration & Receipt of Orders
The rules and regulations for receiving and registering lab orders can be complex. To get paid for services, laboratories must obtain specific information. This module will identify patient information necessary for billing, list various forms used for registering patients and describe their importance, provide at least two examples when Medicare may be the secondary payer for a Medicare beneficiary, identify the correct date of service for laboratory tests, explain why orders/requests for tests must be kept on file, and describe the importance of the National Provider Identification number.
Compliance Topics:
Collecting Patient Registration Information
Additional Patient Registration Information
Patient Registration Forms
Patient Registration Forms- Medicare Secondary Payer
MSP and the Laboratory
Date of Collection
Date of Collection- Stored Specimen Exceptions
Requesting/Ordering Provider Information
Exclusion from Participation
Provider Identification
Invalid Ordering/Referring Providers
Consequences of Listing the Wrong Ordering Provider
Retention of Orders/Referrals
Administrative Simplification Requirements
National Provider Identification
Recommended Audience: Laboratory, Physicians-Employed
Processing Laboratory Orders 2: Types of Laboratory Test Orders
The purpose of this module is to help you learn what you can do to promote compliance when handling different types of orders. This module will list the five hints that can help you identify that you may be working with an unclear order, list the four key pieces of information you need to document when confirming an unclear order, describe what a standing order is and what elements should be present on the order, explain how you can handle a standing order that has expired, identify the timeframe allowed for requesting confirmation of a verbal order, and describe two ways duplicate billing may occur.
Compliance Topics:
Unclear Orders
Unclear Orders-Documentation
Standing Orders
Items to List on Standing Orders
Verbal Orders
Handling Standing Orders-Expired
Billing Considerations with Verbal Orders
Duplicate Orders & Examples
Avoiding Duplicate Billing Situations
Duplicate Billing and the OIG
Recommended Audience: Laboratory, Physicians-Employed
Processing Laboratory Orders 3: Processing Orders
To avoid any compliance violations, laboratories should have procedures in place that promote laboratory compliance.
The course will define unbundling and describe what you can do to identify and prevent unbundling, define the Three-day Outpatient Payment Window Rule and provide examples of when lab services fall under this rule, describe how to report multiple specimens collected from a patient during the same encounter, provide examples of when a specimen collection fee may and may not be charged, explain the differences between reflex testing and confirmatory testing, define handling charges and STAT tests and provide an example of each, explain why handling charges and STAT fees cannot be charged to Medicare, and identify tests that are based on calculations and explain the billing rules that apply.
Compliance Topics:
Bundling of Laboratory Services
Consequences of Unbundling Services
Examples of Unbundling of Orders
Three-day Outpatient Payment Window Rule
Three-day Window – Lab Services
Specimen Collection Fees
Specimen Collection Fees – Separate Payment
When Specimen Collection Fees may not be charged
Travel Allowances
Reflex/Confirmatory Testing
Criteria for Reflex/Confirmatory Testing
Medical Necessity
Testing Ordered & Performed
STAT Test Reports & Handling Charges
Billing for Calculations & QC Tests
Recommended Audience: Laboratory, Physicians-Employed
Laboratory General Compliance 1: Medical Necessity
This module will define medical necessity, identify four key criteria that must be met for Medicare to pay for tests, explain what National and Local Coverage Determinations are and what the differences are between the two, describe the difference between covered and non-covered services and give examples of each, identify when an ordering provider must submit a diagnosis to the laboratory, explain when the Advance Beneficiary Notice of Non-Coverage (ABN) should be obtained, describe the rules for obtaining ABNs for frequency based tests and standing orders, and explain what to do if a patient refuses to sign the ABN but demands the test be performed anyway.
Compliance Topics:
Medical Necessity
Establishing Medical Necessity
Payment & Medical Necessity
Coverage Determinations
Staff’s Role & Medical Necessity
Medical Necessity-Exclusions & Exceptions
Non-covered Services
Requirement to Furnish Diagnostic Information
Obtaining Diagnostic Information
Diagnosis Coding
Advanced Beneficiary Notice
ABN Forms
ABN Requirements
When an ABN should be Obtained
ABN of Non-Coverage
Completing the ABN
Modifying ABNs
Obtaining ABN’s in the Emergency Department
Obtaining ABN’s After Receipt of the Specimen
Patient Options
Patient Options-Choices
Patient Options-Exceptions
Recommended Audience: Laboratory, Physicians-Employed
Laboratory General Compliance 2: Other Compliance Topics
This module will provide you with information about specific regulatory topics affecting laboratories today. The module will describe the Direct Billing Requirement and identify three exceptions to this requirement, explain how the Direct Billing Requirement applies to hospital laboratories, list at least three laboratory discount policies that should be in place and why they are important, describe composite rate tests and identify who should be billed for laboratory tests paid under the composite rate, , describe two scenarios for tests provided to patients in skilled nursing facilities and who should be billed for those tests, define Point of Care testing and list at least three rules for proper reporting of POC testing.
Compliance Topics:
Direct Billing Requirement
State Requirements for Direct Billing
Direct Billing & Hospital Laboratories
Hospital Laboratories and APC’s
Discount Policies
Discount Policies-Documentation
End Stage Renal Disease (ESRD) Testing
ESRD Testing
Testing for SNF Patients
Who to Bill for Tests Performed
Establishing Prices for SNF Services
The OIG, Laboratories & SNF Testing
Point of Care Testing
Charging for POC Testing
Recommended Audience: Laboratory, Physicians-Employed
Home Medical Equipment 1: Criteria
This module will help you understand Medicare’s eligibility criteria for home health equipment.
Compliance Topics:
Definition of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
Reasonable and Necessary
Medical Necessity
Oxygen
Beds & Wheelchairs
Enterals & Parenterals
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Home Medical Equipment 2: Documentation, Billing & Other Compliance Risks
This course is a continuation of Home Medical Equipment 1.
Compliance Topics:
Physician Orders
Delivery
Refills
Medical Necessity
Repairs & Maintenance
Equipment Replacement
Capped Rentals
Pre-billing Audit
Rental of Space
Co-pays, Deductibles & Refunds
Sales & Marketing Practices
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Home Care 1: Regulatory Compliance
This module will provide you with general information about how the regulatory environment affects a Home care provider’s ability to manage the risk of non-compliance and to receive payment for services.
This course will describe your role and how it affects compliance, list the three types of Medicare Administrative Contractors (MACs) and describe the functions they perform, describe the Medicare Conditions of Participation (COPs), describe the difference between certification, licensure and accreditation, define HIPAA and list the three main areas of the administrative simplification provision, explain what the Medicare Claims Processing Manual is and why it is important, and describe the four parts of the Medicare program and the types of services they cover.
Compliance Topics:
Compliance Roles
* Administrator
* Clinical Manager
* Field RN/Therapist/Case Manager
* Home Health Aide
* Performance Coordinator
* Business Office/Finance Staff
Medicare Administrative Contractors (MACs)
MACs: Audits and Reviews
Conditions of Participation (COPs)
Medicare Certification Surveys
Accreditation
Medicare Certification: Non-Compliance
State Licensure
HIPAA Overview
National Provider Identification
Regulatory Information
Reimbursement Regulations
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Home Care 2: Billing Compliance
This module will provide you with general information about how the regulatory environment affects a Home Care provider’s billing practices.
This course will describe the basic requirements for the Home Care admission process, explain Medicare Secondary Payer requirements, list three forms commonly completed during the patient admission process, describe the Advance Beneficiary Notice (ABN) and when it is required, explain the Medicare appeals process for denied claims, and define the Anti-kickback Statute and Stark Laws and give examples of each.
Compliance Topics:
Admission Policies and Procedures
Patient Demographics
Patient Rights & Responsibilities
Verification of Benefits
Medicare as Secondary Payer (MSP)
MSP Compliance
Examples of Medicare as Secondary Payer
Additional Admission Forms
ABN-Overview
When ABNs are Appropriate
Home Health Change of Care Notice and NOMC: Q10 Review
Patient Options
Processing Additional Development Requests & Denials
Responding to ADRs & Denials
Claims Filing: Appeal Timelines
Claims Processing Compliance
Anti-kickback Statute
Examples of the Anti-kickback Statute
Routine Waiver of Co-payments & Deductibles
Stark Laws
Examples of the Stark Laws
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Home Care 3: Documentation Guidelines
This module will provide you with general information about how the regulatory environment affects a Home Care provider’s documentation practices.
This course will name at least three regulatory standards that govern the content of medical records, list at least four key documentation requirements for medical records, define medical necessity, explain how to select the appropriate timeline for obtaining written confirmation of a verbal order, define who is considered an authorized provider and give two examples, and list the minimum information that should be documented when contacting an ordering provider to clarify an order.
Compliance Topics:
Reason for Documentation
Conditions of Participation (COP)
Effective Documentation
Authorized Providers
Verbal Orders
Verbal Orders-Timeframes
Unclear Orders
Unclear Orders-Documentation
Medical Necessity
National & Local Coverage Determination
Medical Necessity & Medicare Refunds
Subcontracted Services
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Home Health 1: Eligibility for Medicare Home Health Services
This course will provide you with general information about how the regulatory environment affects a home health agency’s ability to manage the risk of non-compliance and receive payment for services.
This course will explain the Medicare definition of homebound and provide an example of a homebound patient, name at least three factors necessary for a patient to be considered homebound, identify home health personnel who are authorized to perform skilled home health services, define intermittent or part-time services, explain the components necessary to initiate home care services for a patient, and describe situations where home health services would meet reasonable and necessary criteria.
Compliance Topics:
Eligibility Criteria
Criteria #1: Homebound
Determining Patient’s Homebound Status
Criteria #2: Skilled Care and Qualifying Services
Skilled Care Staff
Criteria #3: Intermittent or Part Time
Intermittent Services
Criteria #4: Under the Care of a Physician
Plan of Care Orders
Recertification Orders
Recertification Orders: Example
Steps for Verbal Recertification
Criteria #5: Reasonable and Necessary
Reasonable & Necessary Determination
Reasonable & Necessary: Examples
Non-Covered Home Services
Able and Willing Caregivers
Able and Willing Caregivers/Examples
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Home Health 2: Home Health Documentation
This course will list two (2) different uses for documentation kept in a patient’s Plan of Care, define the Outcome and Assessment Information Set (OASIS), identify at least two (2) times during a patient’s care when the OASIS must be completed, name three (3) patient groups for whom the OASIS is not required, describe the components of a clinical note, and list some key elements that make documentation effective.
Compliance Topics:
Plan of Care
Plan of Care Documentation
OASIS
OASIS Tool
OASIS: Pitfalls
Completing the OASIS
Completing the OASIS: Exceptions
OASIS Submission Requirements
Clinical Notes
Clinical Notes: Effective Documentation
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Home Health 3: Billing
This course will identify the two split payments that accompany each episode of home health services, list the types of services that must be included on the home health claim, list the types of services that may be billed separately from other home health services, name two types of codes listed on a home health claim, explain the differences between information included in the end of episode claim, and define rebilling and resubmission.
Compliance Topics:
PPS Overview
Low Utilization Payment Adjustment (LUPA)
PPS Payments
Bundled and Consolidated Home Health Services
Excluded Services
One Agency
Health Insurance Query for Home Health (HIGH)
Assisted Living Facility Residents
Plan of Care: Billing
Home Health Charge Entry Process: Coding
Examples of Adjusted HHRG Payments
Home Health Charge Entry Process: Patient Visits
Patient Visit Examples
Home Health Pre-Billing Audit
Home Health Pre-Billing: RAP
Home Health Pre-Billing Audit: End of Episode Claim
Claims Submission
Additional Development Request
Home Health Accounts Receivable
Re-billing/Re-submission
Transfers
Partial Episode Payments
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Hospice 1: Eligibility Criteria for Hospice Services
This course will investigate the eligibility criteria for Medicare hospice services. For a patient to receive care and qualify for reimbursement under his/her Medicare hospice benefit, the care must meet the requirements listed in the Medicare Benefit Policy Manual. The requirements include the following criteria:
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The patient must be certified as
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The hospice services must be reasonable and necessary for the palliation and management of the terminal illness as well as related conditions. The services must also be consistent with the plan of care.
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The patient must have an that meets the hospice certification and election requirements.
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The care must be divided into benefit periods.
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The patient must be under an that is periodically reviewed by the attending physician, medical director, and interdisciplinary group of the hospice program. This plan of care must be established before hospice is provided.
Compliance Topics:
Definition of Hospice Care
Terminal Status and Certification
Specific Requirements Regarding Certifications
Determining Terminality
Benefit Periods
Hospice Election and Revocation
Hospice Evaluation and Counseling Services
Hospice Revocation/Discharge
Covered Diagnosis & LCDs
Interdisciplinary Group
Levels of Care (4)
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Hospice 2: Documentation
Documentation is an important part of receiving reimbursement for the services provided by the hospice agency. This course will review documentation requirements specific to hospice agencies regarding:
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Plan of Care
-
Clinical Notes
Compliance Topics:
The Plan of Care
Clinical Notes
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Hospice 3: Billing
This course discusses the rules and guidelines for billing hospice services. Everyone in the hospice agency has a responsibility to make the billing process compliant with these rules, regulations and guidelines.
Compliance Topics:
Levels of Care and the Daily (Per-Diem) Rate
Per-Diem Rate Services
Availability of Services
Transfers
Hospice Pre-Billing Audits
Hospice Accounts Receivables
Hospice Claims Submissions
Hospice Denied Claims/Rebilling
Hospice Payments & Collections
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Hospice 4: Other Compliance Risks
There are several other risks that must be considered for hospice services. This course will focus on the following topics:
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Hospice Services in a Skilled Nursing Facility
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Hospice Services in an assistant Living Facility
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Improper Incentives for Referrals
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Volunteers
-
Underutilization
Compliance Topics:
Hospice Services in a Skilled Nursing Facility
Responsibilities for Hospices and SNFs/NHs
Hospice Specific Responsibilities
SNF/Nursing Home Specific Responsibilities
Improper Incentives for Referrals
Hospice Services Provided in Assisted Living Facilities
Volunteers
Underutilization
Recommended Audience: Billing/Patient Financial Services, Home Care, Discharge Planning, Hospice
Physician Coding 1: Evaluation & Management Services
The primary focus of this course will be to provide physicians with information on how documentation in the patient chart is used to determine the appropriate Evaluation and Management (E&M) codes for the services they provide, and correspondingly, the payment that is received.
The purposes of this course are:
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To foster and maintain a culture on integrity
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To develop individual and team character and virtue in the workplace
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To foster compliance with Applicable federal and state laws and regulations
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To make sure facility policies and procedures are followed
The AMA established levels for the various categories of Evaluation and Management (E&M) services in the Current Procedural Terminology (CPT®) Manual. To clarify what would be required to support the levels of E&M services, the Centers for Medicare and Medicaid Services (CMS) has developed documentation guidelines to help providers determine which category and level of service to use for each patient encounter.
This course is intended to provide a thorough explanation of the CMS Documentation Guidelines (DGs) and provide the information necessary for you to evaluate your documentation and determine which E&M level is appropriate for every patient encounter
Compliance Topics:
E&M Key Components
E&M Key Components-New versus Established Patient
Patient History
Patient History-Chief Compliant
History of Present Illness
History of Present Illness (HPI) Elements
Review of Systems (ROS)
Review of Systems-Examples
Past Medical, Family, and/or Social History
Determining the Level of History
Examination Background–1985 Guidelines
Examination Background–1997 Guidelines
Examination-Documentation
Types of Examinations
Limited vs. Extended Examination Examples–1995 Guidelines
Examination Documentation
Examination Examples
Determining the Level of Examination
Medical Decision Making
Diagnoses or Management Options
Amount or Complexity of Data
Risk of Complications and/or Morbidity or Mortality
Table of Risks
Established Patient Guidelines
Risk of Complications
Contributory Components
Medical Decision Making-An Example
Medical Decision Making-Putting it Together
Nature of Presenting Problem
Counseling & Coordination of Care
Contributory Components-Time
E&M Code Selection
Score Sheets
Determining the Overall E&M Level of Service-New Patient
Determining the Overall E&M Level of Service-Established Patient
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Coding 2: Special Circumstances
This course addresses additional types of Evaluation and Management (E&M) services as well as other coding and documentation requirements you must follow. This includes:
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Consultations
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Unbundling/Comprehensive Codes
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Teaching Physician Requirements
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Modifiers
Compliance Topics:
Consultations Updated Requirements-Outpatient Services
Consultations-Updated Requirements-Inpatient Services
Other Payer Requirements for Consultations
Unbundling/Comprehensive Codes
Teaching Physician-Requirements
Teaching Physician-Documentation Guidelines
Teaching Physician-Documentation Examples
Teaching Physician-E&M Requirements
Teaching Physician-Specific Procedure Requirements
Modifiers
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 1: Rules & Guidelines
The primary focus of this course will be on proper documentation of services provided by the physician as well as diagnosis coding and billing of services to third party payers, including Medicare and Medicaid, in order to meet existing compliance requirements.
This course will identify the compliance risks facing physicians in the current regulatory environment, provide an understanding of the importance of complete and accurate clinical documentation, provide an understanding of the association between clinical documentation and the billing process, identify the services that will or will not be paid by Medicare and Medicaid, provide an understanding of the components of a compliance program and how you could implement a compliance program in your practice, and provide an understanding of the practices that should be put in place in a physician’s practice to improve compliance with billing and coding laws and regulations.
Compliance Topics:
OIG Annual Work Plans
Recovery Audit Contractors (RACs)
Place of Service Rules
Documentation
Documentation-Signatures
Documentation-Medical Records
Documentation-Abbreviations
Diagnosis Coding
NCDs & LCDs
ABNs
“Incident To” Guidelines
Non-Physician Practitioners
Split or Shared Visits
Completion of Discharge Summaries
Joint Commission Requirements
Three-Day Outpatient Window Rule
Observation Status/Examples
Observation Status Guidelines
Physician Compliance Programs
2-Midnight Rule
Seven Compliance Standards
Four Risk Areas
Fourteen “OIG Highlights”
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 2: Anesthesia Specialty Guidelines
This course contains additional information on compliance rules and regulations specific to Anesthesia Specialties.
Compliance Topics:
Time/Unbundling
Medical Direction
Modifiers
Pulse Oximetry
Ventilation Management
Pre-Anesthesia Visit
E&M Codes/Consultations
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 3: Obstetrics & Gynecology Specialty Guidelines
This course contains additional information on compliance rules and regulations specific to Obstetrics & Gynecology Specialties.
Compliance Topics:
Preventive Medicine Services
Modifier Abuse
Global Billing/Unbundling
Co-Surgery
Assistant at Surgery
Certified Nurse Midwife (CNM)
CNM Modifiers
Physician E&M Codes
PATH
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 4: Critical Care Specialty Guidelines
This course contains additional information on compliance rules and regulations specific to Critical Care Specialties.
Compliance Topics:
Time
Location
Unbundling
NICU Billing
NICU Unbundling
Physician E&M Codes
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 5: Cardiology Specialty Guidelines
This course contains additional information on compliance rules and regulations specific to Cardiology Specialties.
Compliance Topics:
Myocardial Perfusion Imaging
Global Surgical Services
Unbundling
National Correct Code Initiatives (NCCI)
Cardiac Catheterizations
EKGs
Pulse Oximetry
Ventilation Management
Modifer Uses
Modifer 25, 59
Critical Care
Time
Physician E&M Codes
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 6: Surgery Specialty Guidelines
This course contains additional information on compliance rules and regulations specific to Surgery Specialties.
Compliance Topics:
PATH
Co-Surgery
Assistant at Surgery
Unbundling
Modifier Use/Abuse
Pulse Oximetry
Ventilation Management
Critical Care
Time
Global Surgical Package
Physician E&M Codes
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 7: Psychiatry Specialty Guidelines
This course contains additional information on compliance rules and regulations specific to Psychiatry Specialties.
Compliance Topics:
Medical Necessity
Upcoding
Psychotherapy with Medical E&M
Unbundling
Time
Batch Documentation
Group Psychotherapy
Psychological Testing
“Incident To” Billing
Clinical Psychologist Services
Clinical Social Workers/Services
Psychiatric Diagnostic Interview
Diagnostic Coverage Limitations
Diagnostic Documentation Requirements
Physician E&M Codes
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 8: Nephrology Specialty Guidelines
This course contains additional information on compliance rules and regulations specific to Nephrology Specialties.
Compliance Topics:
PATH
Unbundling
Dialysis
Monthly Capitation Payment
Modifier Use
Physician E&M Codes/Consultations
Recommended Audience: Physician Office Staff, Physicians-Employed
Physician Documentation 9: Family Practice & Internal Medicine Specialty Guidelines
This course contains additional information on compliance rules and regulations specific to Family Medicine & Internal Medicine Specialties.
Compliance Topics:
PATH
Preventive Medicine Services
Modifier Use
EKG/Radiology
Unbundling
Pulse Oximetry
Ventilation Management
Critical Care
Time
NICU Billing
Physician E&M Codes
Recommended Audience: Physician Office Staff, Physicians-Employed
EMTALA : The Basics (Core Module)
The Core EMTALA module will address the definition of an Emergency Medical Condition, EMTALA requirements, and applying EMTALA at your facility. This course will identify the basic requirements of EMTALA, name at least three instances when the EMTALA obligation for a hospital ends, define “Medical Screening Examination”, describe a situation when an unstable patient may be transferred to another facility, and identify many of the compliance issues related to EMTALA.
Compliance Topics:
Overview of EMTALA
Emergency Medical Condition Defined
Medical Screening Examination Defined
“Comes to the Emergency Department” Defined
Dedicated Emergency Department Defined
Hospital Property Defined
EMTALA Requirements
EMTALA and Registration
Medical Screening Examinations (MSEs)
Patient Selection and EMTALA Violations
Physician Scope of Privileges
Stabilization or Transfer of Patients
Entities Affected by EMTALA
Hospital Property: Examples
Dedicated Emergency Department (DED)
What is Considered a DED
What is Not Considered a DED
When EMTALA Begins
EMTALA Applicability to Requests for Care
Outpatient Services
EMTALA and Inpatient Services
When does EMTALA End
Recommended Audience: General Staff (Non-Emergency Department, Non-Physicians, Non-Management)
EMTALA: Combined Module
The Combined EMTALA module will cover the MSE, stabilization and transfers, documentation required under EMTALA, the applicability of EMTALA at other facilities, on-call coverage, and EMTALA investigations. The module will define “Medical Screening Examination”, list the qualified individuals capable of providing the MSE, understand the requirements for stabilization and transfer, understand the documentation requirements under EMTALA, identify entities affected by EMTALA, understand on-call coverage requirements, and list potential sources of EMTALA allegations.
Compliance Topics:
What is a MSE
EMTALA Definition of MSE
Providing the MSE
Who Provides the MSE
When is a MSE Provided
Why is a MSE Needed
How is an MSE Conducted
MSE Scenarios
Documenting the MSE
Stabilization & Transfer
Stabilization Definitions
Unstable Patients
Patients Refusing Emergency Treatment
Transfers
Appropriate Transfers
Acceptance of Transfers
Transfer Certification
Patient Request for Transfer
Documenting the MSE
Documentation for Patients Refusing Emergency Treatment
Transfer Certification
Documenting Patient Request for Transfer
Documenting Transfers
Transfer Summary Form
Transfer Summary Form: Common Pitfalls
Documenting On-call List
Required Signage
Central Log
Entities Affected by EMTALA
Provider-Based Status and EMTALA
What is Considered a DED
Who is Not Considered a DED
Hospital Property
Hospital Property: Examples
Off-Campus Departments
Ambulance Services
Non-Provider-Based Facilities
Physician Scope of Privileges
On-Call List
Physician On-Call Requirements
Additional On-Call Requirements
Physician Benefits of On-Call Coverage
Consequences of On-Call Coverage
Use of Non-Physician Practitioners
CMS Interpretive Guidelines
Updating the On-Call Schedule
Sending Patients to the Physician’s Office
EMTALA Investigations
Sources of Allegations
Investigating Agency
Investigation: Record Review
Peer Review by CMS
Medical Review by CMS
Penalties and Enforcement
Fines and Other Penalties
Trends in Enforcement
Recommended Audience: Managers, ED Physicians, ED Personnel, Urgent Care and Provider-Based Staff
EMTALA 1: Medical Screening Examination (Supplemental Module)
This course is intended for all ED personnel and addresses the requirements of and issues associated with the MSE. This supplemental course will cover the aspects of a MSE, define “Medical Screening Examination”, and list the qualified individuals capable of providing the MSE.
Compliance Topics:
What is a MSE
EMTALA Definition of MSE
Providing the MSE
Who Provides the MSE
When is a MSE Provided
Why is a MSE Needed
How is an MSE Conducted
MSE Scenarios
Documenting the MSE
EMTALA 2: Transfers & Stabilization (Supplemental Module)
This course is intended for all ED personnel and addresses the requirements of and issues associated with transfers and stabilization. This supplemental module we cover Stabilization and Transfers under EMTALA. The course will describe a situation when an unstable patient may be transferred, define a transfer, and list at least three items to document when transferring a patient.
Compliance Topics:
Stabilization & Transfer
Stabilization Definitions
Unstable Patients
Patients Refusing Emergency Treatment
Transfers
Appropriate Transfers
Acceptance of Transfers
Transfer Certification
Patient Request for Transfer, Risks and Benefits
EMTALA 3: Documentation (Supplemental Module)
This course is intended for ED personnel, particularly ED physicians and addresses the requirements and issues associated with documentation when EMTALA applies. This supplemental course focuses on appropriate documentation of the MSE, a patient’s refusal of emergency treatment, patient transfer, and the on-call coverage list. The course also covers required EMTALA signage and maintenance of a central log.
Compliance Topics:
Documenting the MSE
Documentation for Patients Refusing Emergency Treatment
Transfer Certification
Documenting Patient Request for Transfer
Documenting Transfers
Transfer Summary Form
Transfer Summary Form: Common Pitfalls
Documenting On-Call List
Required Signage
Central Log
EMTALA 4: Applying EMTALA at Other Facilities (Supplemental Module)
This course is intended for managers and staff of urgent care and provider-based locations. This course will cover a variety of topics related to applying EMTALA at facilities other than the hospital and it’s on-campus departments. The course will identify the entities affected by EMTALA, provide two examples of “Hospital Property”, and define and identify a “Dedicated Emergency Department”.
Compliance Topics:
Entities Affected by EMTALA
Provider-based Status and EMTALA
What is Considered a DED
What is Not Considered a DED
Hospital Property
Hospital Property: Examples
Off-Campus Departments
Ambulance Services
Non-Provider-Based Facilities
EMTALA 5: On-Call Coverage (Supplemental Module)
This module is intended for ED physicians and managers. This course will describe the type of information that is maintained on a facility’s on-call list, list at least three benefits for physicians who provide on-call services, and identify who is responsible for determining whether the on-call physician must physically see the patient or whether the services can be handled by a non-physician practitioner.
Compliance Topics:
Physician Scope of Privileges
On-Call List
Physician On-Call Requirements
Additional On-Call Requirements
Physician Benefits of On-call Coverage
Consequences of On-Call Coverage
Use of Non-Physician Practitioners
CMS Interpretive Guidelines
Updating the On-Call Schedule
Sending Patients to the Physician’s Office
EMTALA 6: Investigations (Supplemental Module)
This course is intended for managers. EMTALA investigations are performed by the Centers for Medicare and Medicaid Services (CMS) and address policies and processes. This course will name three situations that may result in an EMTALA investigation, and describe the potential fines and penalties imposed by the OIG for EMTALA violations.
Compliance Topics:
EMTALA Investigations
Sources of Allegations
Investigating Agency
Investigation: Record Review
Peer Review by CMS
Medical Review by CMS
Penalties and Enforcement
Fines and Other Penalties
Trends in Enforcement
HIPAA Compliance - Courseware include Scenarios, Examples & Testing
HIPAA 1 for General Staff
This course will provide you with important information about the laws and regulations that affect the healthcare industry and your organization. Upon completion of this course, you should: (1) Have a basic understanding of HIPAA-the law that protects patient health information, and (2) Know your reporting obligations if you suspect a privacy violation.
HIPAA Compliance Topics:
Protected Health Information (PHI)
Notice of Privacy Practices (NPP)
PHI-Use and Disclosure
PHI-Treatment, Payment, & Operations (TPO)
PHI-Public Health Reporting
PHI-Opportunity to Agree or Object
Minimum Necessary Rule
Incidental Disclosures
Texting & Social Media
Security
Security-Email & Internet Use Guidelines
Security-Facility
Security-Breach Notification
Patient Rights Under HIPAA
Reporting
HIPAA for Management & Physicians
This course will provide you with important information about the laws and regulations that affect the healthcare industry and your organization. Upon completion of this course, you should be able to: (1) Define PHI and explain how it may be used or disclosed, (2) Describe patient rights with respect to PHI, and (3) Describe the tools used to safeguard PHI.
HIPAA Compliance Topics:
Notice of Privacy Practices (NPP)
Protected Health Information (PHI)
Texting & Social Media
Admissions & Registration
Incidental Disclosures
Patient Care
Security
Breach Notification
Medical Records
Administration & Hospital Operations
Document Retention
HIPAA for Medical Records Personnel-Both Staff & Management
This course will provide you with important information about the laws and regulations that affect the healthcare industry and your organization. Upon completion of this course, you should be able to: (1) Understand patient rights: Access, Amendment, Accounting Disclosures, Authorizations, Request for Restrictions, Request for Confidential Communications, and (2) Define PHI and describe the safeguards in place to protect patient information.
HIPAA Compliance Topics:
Patient Rights
Protected Health Information (PHI)
Access to PHI
Texting & Social Media
Patient Access to PHI
Denial Access
PHI-Disclosures
PHI-Authorizations
PHI-Minimum Necessary Rule
Amendments
Amendment Denials
Accounting of Disclosures of PHI
Disclosures Required to be an Accounting Verification of Identity & Authority
Disclosures NOT Required to be an Accounting Verification of Identity & Authority
Business Associates
Security
Incidental Disclosures
Breach Notifications
Note:
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Courses are updated on a regular basis
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Courses can be further customized to meet organizational requirements
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Courses have been designed to fit into any Learning Management System (LMS)
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Courses contain real healthcare scenarios
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Courses included testing for comprehension
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Courses can be “bookmarked”
Healthcare Experience
Our Subject Matter Experts are comprised of highly qualified healthcare professionals specializing in regulatory compliance with extensive experience in acute care reimbursement, physician payment, inpatient/outpatient coding and documentation, and financial analysis. Included in this group of professionals are physicians, registered nurses, certified coding specialists, registered records administrators, certified public accountants and attorneys.
For the better part of the last decade, our Subject Matter Experts has been extremely active with investigations and negotiations on behalf of providers with the Department of Justice ("DOJ"), Office of Inspector General ("OIG") and the Federal Bureau of Investigations ("FBI"). Specifically, our Subject Matter Experts have served numerous health industries clients with negotiating corporate integrity agreements ("CIA") and investigation settlements with various state United States Attorney Offices and local OIG offices, as well as serving as the independent review organization ("IRO").
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