HealthStream Brands

Nursing Facility Compliance

Nursing facilities are seeing all aspects of their operations put under increased government scrutiny. Federal and State government agencies are performing audits of the services provided and carefully inspecting the way services are documented, coded and/or billed. In addition, audits for the quality of care given to residents are becoming commonplace. Implementing an effective compliance training program is a necessity to protect your organization. This online course provides education for staff about how fraud, waste and abuse can be avoided, detected and deterred.

1 to 100 Learners?

Number of Learners:

More than 100 learners?

Course Outline

  • INTRODUCTION
    • The Seriousness of Fraud Allegations
    • Goals of a Compliance Program
    • The Ethical Basis for Compliance
    • Ethical Behaviors and Self Monitoring Techniques
  • COMPLIANCE RISK AREAS
    • Confidentiality of Information
    • Documentation and Coding
    • Billing and Reimbursement
    • Illegal Provider Relationships
    • Managed Care
    • Other Risk Areas
    • Deficit Reduction Act of 2005
    • Government Sanctions
  • COMPLIANCE PROGRAM
    • Seven Elements of Compliance Programs
    • An Eighth Element
    • Indicators for Evaluation
  • DOCUMENTATION AND CODING
    • Medical Necessity
    • Bundling/Unbundling
    • Advance Beneficiary Notification (ABN)
    • OIG Work Plan Issues 
  • COMPLIANCE REVIEW 
    • Health Care Administrator 
    • Billing Manager 
    • Coder 
    • Housekeeping/Maintenance
  • BILLING AND REIMBURSEMENT 
    • Billing for Items and Services Not Rendered or Not Documented 
    • Resident Assessment Instrument (RAI) 
    • 3 Day Qualifying Hospital Stay 
    • Duplicate Billing 
    • Credit Balances 
    • Bad Debts 
    • Consolidated Billing 
    • Minimum Data Set
  • RESIDENT CARE RISK AREAS 
    • OIG Work Plan Issues 
    • Quality of Care Principles 
    • Resident Safety 
    • Credentialing 
    • Skilled Nursing Facility Quality Initiatives 
    • OIG Skilled Nursing Facility Work Plan

Target Audience

  • Administrative Staff
  • Coding/Billing Staff
  • Food Services Staff
  • Maintenance/Housekeeping Staff
  • Medical Director
  • Nursing Staff
  • Occupational Therapists
  • Physical Therapists
  • Speech Therapists