The AIS Guide to Medicare Compliance Risks & Strategies

The AIS Guide to Medicare Compliance Risks & Strategies helps you stay current on the big-dollar topics of greatest concern to health care compliance professionals and anyone responsible for running a Medicare program.

In addition to the “usual” compliance issues related to billing, coding and documentation, plus Stark, HIPAA and FTC ‘Red Flags’, the Obama administration is taking an aggressive stand against Medicare fraud, waste and abuse. And with health care reform taking center stage, legislators are looking to Medicare dollars as a possible source of funding – meaning increased scrutiny and enforcement actions.

Containing both overview and analysis – along with field-tested tools – The AIS Guide to Medicare Compliance Risks & Strategies can help you avoid problems before they occur. Its nine information-filled chapters cover everything from coding, billing, documentation and reimbursement, to Recovery Audit Contractors and OIG audits, as well as:

ICD-10 implementation
Payment for HACs and never-events
Medical necessity
Standing orders
RAC high-risk areas
Electronic health records
Admissions procedures
Gainsharing arrangements
PHI
And much, much more

Discover effective strategies developed by compliance officers from across the country, help reduce your compliance risks and strengthen your compliance program’s effectiveness. Order The AIS Guide to Medicare Compliance Risks & Strategies today!

Also Available on CD: For an additional $150, you can order the convenient CD version of The AIS Guide to Medicare Compliance Risks & Strategies. The CD contains all of the information in the print version and you’ll find what you need instantly with the user-friendly, searchable PDF format. Plus, all CD purchasers receive a free copy of the print version!

Table of Contents

Methodology

Chapter 1: Medicare Coding and Billing Issues

Risk Areas
Error Prevention
ICD-10 Implementation Issues

Chapter 2: Payment and Reimbursement Issues

Medical Necessity
Observation Vs. Inpatient Admission
Payment for Hospital Acquired Conditions (HACs), Never Events and Other Medical Errors
Overpayments
High-Dollar Cases

Chapter 3: Documentation

Standing Orders
Physician Signatures
Physician Queries
Documentation Clarity
Diagnostic Testing

Chapter 4: Recovery Audit Contractors and Other Audit Areas

Federal Guidelines for RACs
Audit Strategies
RAC High-Risk and Target Areas

Chapter 5: Compliance Processes and Administrative Strategies

Admissions Procedures, Including EMTALA
Gifts and Entertainment
Case-Management Protocol
Disclosure and Transparency
Electronic Health Records
Quality Initiatives
Tools and Technology
Training and Education
Provider/ Pharmaceutical Relationships
Attorney-Client Privilege

Chapter 6: Fraud and Abuse, False Claims

False Claims Act
Durable Medical Equipment Fraud and Abuse
Federal Fraud Oversight and Legislative Efforts
Judgments and Settlements

Chapter 7: Anti-Kickback and Stark Physician Self-Referral Laws

Stark Federal Guidance
Strategies for Complying With Stark
Stark Violations and Enforcement
Gainsharing Arrangements
Anti-Kickback Statute

Chapter 8: OIG Audits and Settlements

Audits
Rulings, Opinions and Guidance
Settlements and Recoveries

Chapter 9: Patient Privacy and Data Security

Safeguarding Protected Health Information
Patient Records Breaches
EHRs and Other Data Security Issues
Federal and State Laws and Regulations
- Security Breach Notification Laws
- FTC Red Flag Rule
- Other Enforcement Actions
Identity Theft Breaches and Strategies
Lawsuits, Settlements and Covered Entity
HIPAA and Law Enforcement
HIPAA’s Impact on Research
Other Strategies for HIPAA Covered Entities

Appendix A: The Seven Elements of a Compliance Program

Appendix B: OIG Notice, Jan. 31, 2005, OIG Supplemental Compliance Program Guidance for Hospitals

Appendix C: OIG Notice, Feb. 23, 1998, Publication of the OIG Compliance Program Guidance for Hospitals

Master Table of Contents
Index of Charts

Written By

The AIS Guide to Medicare Compliance Risks & Strategies was written and edited by the editorial staff of Atlantic Information Services and Report on Medicare Compliance. Nina Youngstrom, managing editor of AIS's Report on Medicare Compliance, has written the newsletter for 17 years and has unique access to compliance leaders in both government and the health care industry. Her extensive contacts and experience permit her to quickly transform today’s news into tomorrow’s most effective compliance strategies.

Written For

Hospitals and health systems
Group practices
Health plans
Other facilities

AIS Guarantee

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