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Professional Compliance

Healthcare compliance continues to evolve with increased scrutiny on healthcare fraud, coding and documentation, referral guidelines, the OIG Work Plan and other critical risk areas. The HCCS Professional Compliance online training library educates key employees on these areas and more to reduce fraud and abuse risks, improve the accuracy and completeness of billing and collections, and improve the quality of patient care.

Accredited by the ACCME for Type 1 CME credit hours

Number of Learners:

Course Outline

Compliance Program
  • Requirement under the Affordable Care Act
  • US Sentencing Guidelines seven essential elements
  • Self-assessment
Compliance Risk Areas
  • Erroneous billing practices
  • OIG Work Plan
Stark Law
  • Prohibited referrals
  • Exception requirements
  • Reporting and sanctions
Anti-Kickback Statute
  • Prohibited kickbacks
  • Key elements
  • Safe harbors
  • Reporting and sanctions
Basic Documentation
  • Documentation for evaluation and management services
  • Documentation in the hospital setting
  • Documentation failures
Medical Identity Theft
  • Forms of medical identity theft
  • Tax fraud
Teaching Physician Rules
  • General rules
  • Documentation by students
  • Evaluation and management services
  • Primary care center exception
  • Time-based services
  • Surgeries and procedures
  • Chief Residents and Fellows
Special Interest Topics
  • Physician supervision of diagnostic tests
  • Clinical trials
  • Open payments

Target Audience

  • Directors/Trustees
  • Medical Staff Leadership
  • Medical Staff Members
  • Community/Private Practice Physicians
  • Medical Directors/Contracted Physicians
  • Employed Physicians
  • Mid-level Providers (PA, NPP, etc)
  • Physician Faculty
  • Fellows, Residents
  • Interns
  • Members, affiliated groups (i.e. Physician-Hospital Organizations)
  • Biller/Coder