Guidance For Prevention And Federal Compliance

With a specific end goal to hold fast to the HIPAA law strategies must be executed by medical facility chairmen for all healthcare workforce and offices to take after as required by law. In light of all the new advances in innovation alongside patient(s) winding up increasingly included with their wellbeing and treatment, HIPAA made ready for everybody to feel secure while giving and getting care. HIPAA law and strategy are of second nature to each other since it assigns a vast number of data, for example, medicinal records, individual data, and healthcare plans.

HIM Personnel play an important role in the Medicare system. Medicare has transitioned from “fee for service” to providing incentive payments for providers that issue high quality care at affordable prices. In order to achieve the “pay-for-quality” incentives hospitals and health care officials must improve their documentation processes. “If it isn’t documented, it wasn’t done” is more important than ever. It is the responsibility of the HIM professional to ensure the integrity of the patient chart. HIM professionals monitor the quality of documentation and ensure all clinical documentation is complete and accurate. HIM professionals are the key to identifying process problems while keeping in mind patient safety, quality of care, and revenue integrity. Medicare requires that hospitals report quality improvement measures in order to receive payments; HIM professionals can directly impact Medicare incentive payments. HIM professionals are directly involved with the Medicare Audit Improvement Act. The HIM professional collects health data that is subject to the audits; HIM professionals are the point of contact for responding to Medicare audit requests.

Healthcare technology has grown and evolved over time. With the conversion to electronic medical records and the creation of social media just to name a few, ensuring patient privacy is of the utmost importance for healthcare facilities in this day and age. In order for an organization to avoid hefty fines, it is imperative that a healthcare administrator maintains compliance with the standards and regulations associated with the Health Insurance Portability and Accountability Act (HIPAA). This paper will provide a summary

The Clinical Documentation Improvement (CDI) has emerged as the most vital drive for overcoming the issues associated with maintaining a complete and good sound medical record in the U.S healthcare system. The main focus of CDI is to enhance clinical clarity of the health records which usually involves the process of improving the medical/health records documentation in order to promote effective patient outcome, data quality measures and accurate reimbursement for services and care rendered. For a medical record to be meaningful and mirror the scope of treatment and services provided, it must be accurate and meet the established guidelines set forth by the governing bodies such as the Centers for Medicare and Medicare.

Regulation placed upon the healthcare system only seek to improve safety and security of the patients we care for. The enactment of the Health Insurance Portability and Accountability Act (HIPPA) and the enactment of Meaningful Use Act the United States government has set strict regulations on the security of health information and has allotted for stricter penalties for non-compliance. The advancement of electronic health record (EHR) systems has brought greater fluidity and compliance with healthcare but has also brought greater security risk of protected information. In order to ensure compliance with government standards organizations must adapt

The value of CDI clinical documentation improvement (CDI) programs are important to any facility that recognizes the requirement of complete and accurate patient documentation. Documentation is very critical because it validates the care that was given. Furthermore, it shares important data to the caregiver and improve claims processing (Leventhal,2014). The three challenges are getting physicians to buy into the program, physicians are extremely busy so they are not connecting the dots on clinical documentation, and training the physicians to get them to understand they need to do better documenting (Leventhal,2014).

Manuals, webinars, and the Medicare Learning Network are three excellent resources for managers to seek the most up to date information for their employees. These suggestions will assist health care organizations in obtaining the much-needed reimbursements through the proper policies and

The advancement of these types of compliance plan guidance’s is established on our trust that a health care professional can use internally restraint to more proficiently observe adherence to appropriate decrees, regulations and plan requirements. Foundations for an Effective Compliance Program: This compliance guidance for physician practices includes features that the OIG has persisted to be the foundation for an effective compliance program:

The purpose of this assignment is to review the factual content of and critically reflect upon the legal compliance considerations of eight major areas including, the Joint Commission, HIPAA/HITECH, Health Finances, Revenue Cycles, Medicare Recovery Audit Contractors, OIG work plan, OIG Corporate Integrity Agreement (CIA), the False Claims Act, and compliance and Provider Self Disclosure Protocol. These key elements have been provided by the GRC software Compliance 360 webpage.

Attempts to stop fraud were enhanced under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The purpose was to improve the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system. This public law encouraged the development of a health information system through standards and requirements for the electronic transmission of certain health information (aspe.hhs.go). The Act established a program to take action against fraud committed against public and private health plans. The legislation required the establishment of a national Health Care Fraud and Abuse Control Program (HCFAC), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS) acting through the Department 's Inspector General (HHS.gov). The HCFAC program is designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse. The Act requires HHS and Department of Justice (DOJ) detail in an Annual Report the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such deposits. (HHS.gov) I will summarize the impact of these laws as it pertains to how they are impacting the healthcare delivery system. (HHS.gov)

Although the overall state of compliance for the organization is good, there are several areas that have been identified as “Priority Focus Areas” due to a past history of nonconformities. All these areas are related to Information Management and Record of Care, Treatment, and Services, in particular:

According to the new law the OIG’s effectiveness will be detecting fraud and abuse by expanding access to and uses of data for conducting oversight and law enforcement activities, including data-matching agreements between agencies. (Gatty, 2010). The HHA will establish procedures for screening providers and suppliers participating in Medicare, Medicaid and the Children’s Health Insurances program to prevent

The transformation of health care through the use of Health Information Technology continued with the passing of the Patient Protection and Affordable Care Act of 2010, which mandated the integration of physician quality reporting and Electronic Health Record reporting. This Act required the creation of measures and reporting of the “meaningful use of the electronic health record” and “quality of care furnished to an individual.” In doing so, the law directly links the adoption of the electronic health record with quality of care to the patient. This entails coordination which the Act requires the use of electronic health

Information overload is a significant liability that a majority of the clinicians, working in the healthcare facilities within the United States of America, face. Due to the fact that the adoption of the EHR leads to the storage of virtually large amounts of data concerning patients; it is difficult for the clinicians to review all the relevant health information of the patients in a limited timeframe. In this case, a legal suite may ensue in the event that a clinician omits some crucial information relevant for treatment while reviewing records for a patient. The clinician could be sued for negligence with the understanding that the information was at his/her disposal (Blumenthal & Tavenner, 2013).

Implementing all of these standards and policies within a company is certainly not an easy thing to do, and therefore it is imperative to understand whether or not your company will need it or not. In fact, it is easy to say that any company working within the federal healthcare system, whether it be insurance, practice, healthcare education, or many others, will need this sort of regulation used efficiency internally in order to prevent federal violations, which will be entirely detrimental to your reputation and ability to produce a