HealthStream Brands

Corporate Compliance

Medical personnel cannot afford to risk the lawsuits and other consequences associated with failing to comply with internal standard operating procedures that are established in compliance with the multiple regulatory bodies overseeing healthcare processes and operations. Our General Compliance suite is a cost-effective way to avoid the risks of fraud and abuse and to reduce the costs associated with employee compliance education. For efficiency, sections are targeted towards specific personnel and functions within a medical organization. For Medicare/Medicaid compliance, our course not only deals with issues relating to billing but also quality of service issues such as Medicare's Hospital Quality Oversight Initiative. The Corporate Compliance component deals with many other issues that can derail the progress of your healthcare organization, including hospital compliance, managed care, and labor laws. This course is important if you are concerned about protecting your institution from potentially damaging lawsuits and government penalties. This course also helps organizations comply with the training requirements of Corporate Integrity Agreements (CIAs).

1 to 100 Learners?

Number of Learners:

More than 100 learners?

Course Outline

  • INTRODUCTION
    • Explanation of possible repercussions
      • Loss of public trust, fines, penalties
    • The ethical basis for compliance
    • Key concepts from the OIG's "Corporate Responsibility and Corporate Compliance" Guidance for Board of Directors
  • COMPLIANCE RISK AREAS
    • Confidentiality of Patient Information
    • Documentation and Coding
    • Billing and Reimbursement
    • Illegal Provider Relationships
    • Anti-Dumping Regulations
    • Managed Care
    • Labor Laws
    • Conflicts of Interest
  • COMPLIANCE REVIEW
    • Health Care Administrator
    • Billing Manager
    • Coder
    • Emergency Room Physician
    • Housekeeping/Maintenance
  • ELEMENTS OF A COMPLIANCE PROGRAM
    • Overview of OIG Guidance
  • DOCUMENTATION AND CODING
    • Medical Necessity
    • Upcoding
    • Bundling/Unbundling
    • DRG Creep
    • PATH Requirements
    • Advanced Beneficiary Notification (ABN)
    • Medicare as Secondary Payer (MSPs)
    • Lab Services
    • Emergency Care Diagnosis Coding
    • Compliance Monitoring
  • BILLING AND REIMBURSEMENT
    • Billing for items and Services Not Rendered or Not Documented
    • 72 Hour Rule
    • Discharge in Lieu of Transfer
    • Duplicate Billing
    • Balances
    • Cost Reports
    • Bad Debts
    • Ambulatory Payment Classifications (APCs)
  • OTHER RISK AREAS
    • Environmental Law
    • Research Compliance Issues
    • Marketing
    • Tax-exempt Status
    • Medical Records Creation/Retention
    • Long-Term-Care Hospital Payments
    • Consecutive Inpatient Stays
    • Outlier Payments
    • ER Diagnostic Tests
    • Cardiac Rehabilitation Services
    • Hospital Outpatient vs. Physician Coding
  • PATIENT CARE RISK AREAS
    • Medical Error Reduction
    • Restraint-related Deaths
    • Patient Safety Standards
    • Medicare's Hospital Quality Oversight Initiative
    • Medication Safety
    • Health Compliance Issues
    • Documentation and Quality Patient Care

Target Audience

  • Admin/Mgr. - Billing
  • Admin/Mgr. - Coding
  • Admin/Mgr. - General
  • Admitting/Registration
  • Biller/Coder
  • Board of Directors
  • Clerical/Admin Staff
  • Corporate Officers
  • IS/Technical Staff
  • Medical Records Staff
  • Non-Physician Provider
  • Non-Clinical Support Staff
  • Patient Care Staff
  • Physician
  • Others