HIPAA Flash Cards CHC.docx

HIPAA Flash Cards, Set 1-52 from Frank Ruelas; Updated by Carl Russell 11/5/2018. 1. Compliance Program Following rules and regulations 2. Integrity Program Values doing the right thing Page 1 of 26

HIPAA Flash Cards, Set 1-52 from Frank Ruelas; Updated by Carl Russell 11/5/2018. 3. Current Compliance activities in many organizations  Equal Employment Opportunity Commission (EEOC)  Employee Retirement Income Security Act (ERISA)  Wage and Hour Rule  Occupational Safety and health Administration (OSHA)  Nuclear Regulatory Commission  Joint Commission on Accreditation of Healthcare Organization (JCAHO)  Research compliance 4. What is a Compliance Program?  Prevention, Detection, Collaboration, and Enforcement  System of policies and procedures developed to assure compliance with and conformity to all applicable federal and state laws governing organization  Ongoing process, part of fabric of organization, commitment to ethical way of conducting business Page 2 of 26

HIPAA Flash Cards, Set 1-52 from Frank Ruelas; Updated by Carl Russell 11/5/2018. 5. Who needs compliance? Why?  Physicians practices  Medicare  Ambulance Services  3rd Party Billing  Pharmaceutical Manufacturing  Hospitals  Laboratories  DME  Home Health Memory aid: APRN & 3 MD work In HHHC 6. HHS Office of Inspector General (OIG) in conjunction with Justice Department is responsible for enforcing the rules and regulations under HHS Office of Inspector General (OIG) in conjunction with Justice Department is responsible for enforcing the rules and regulations under Medicare/Medicaid laws outlined as part of the Social Security Act and administered by CMS Page 3 of 26

HIPAA Flash Cards, Set 1-52 from Frank Ruelas; Updated by Carl Russell 11/5/2018. 7. Government estimates on fraud 10% of total US health care expenditures, about $100 billion annually 8. Justice Department (priorities)  Violent Crime - 1st Priority  Health care fraud - 2nd Priority Page 4 of 26

HIPAA Flash Cards, Set 1-52 from Frank Ruelas; Updated by Carl Russell 11/5/2018. 9. Benefits of Compliance Program  Safeguards organization legal responsibility to abide by applicable laws and regulations  Demonstrate to employee and community the organization's commitment to good corporate conduct  Identify and prevent criminal and unethical conduct  Improve the quality of patient care  Create a centralized source of info on health care regs  Develop a methodology that encourages employees to report potential problems  Develop procedures that allow the prompt, thorough investigation of alleged misconduct  Initiate immediate and appropriate corrective action  Reduce the organization remedies, such as program exclusion 10. Why Compliance Programs are Essential  Payback to fiscal intermediaries or carriers may result in audited services  Probation and court imposed programs  Government designed programs  Exclusion from government program  Reduced threat of qui tam (whistle-blower) lawsuit Page 5 of 26

HIPAA Flash Cards, Set 1-52 from Frank Ruelas; Updated by Carl Russell 11/5/2018. 11. OIG Top 10 Reasons to Implement a Compliance Program (1-5)  Adopting a compliance program concretely demonstrates to the community at large that a provider has a strong commitment to honesty and responsible corporate citizenship.  Compliance programs reinforce employee's innate sense of right and wrong.  An effective compliance program helps a provider fulfill its legal duty to government and private payers.  Compliance programs are cost effective.  A compliance program provides a more accurate view of employee and contractor behavior relating to fraud and abuse. 12. OIG Top 10 Reasons to Implement a Compliance Program (6-10)  The quality of care provided to patients is enhanced by an effective compliance program.  A compliance program provides procedures to promptly correct misconduct.  An effective compliance program may mitigate any sanction imposed by the government.  Voluntarily implementing a compliance program is preferable to waiting for the OIG to impose a Corporate Integrity Agreement (CIA).  Effective corporate compliance programs may protect corporate directors from personal liability. Page 6 of 26

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