The AIS Guide to Medicare Compliance Risks & Strategies for Hospitals, Physician Groups and Other Providers

The AIS Guide to Medicare Compliance Risks & Strategies for Hospitals, Physician Groups and Other Providers provides guidance and insight into the big-dollar topics of greatest concern to health care compliance professionals and anyone responsible for running a Medicare program, such as:
-Billing, coding, documentation and reimbursement
-Stark
- HIPAA
-FTC 'Red Flags'
- Recovery Audit Contractors and OIG audits
-Medicare fraud, waste and abuse
-Enforcement actions

Use The AIS Guide to Medicare Compliance Risks & Strategies to discover effective strategies developed by compliance officers from across the country, help reduce your compliance risks, and strengthen your compliance program's effectiveness.

The AIS Guide to Medicare Compliance Risks & Strategies is packed with worksheets, flow charts, checklists, sample forms and policies, and other practical tools from compliance experts nationwide, to help with the toughest compliance areas:
-Preparing for ICD-10 and HIPAA 5010
-Conducting a risk analysis and compliance audits
-Billing for nonphysician services, physician observation services, and for blood and blood products
-Issuing an Advance Beneficiary Notice
-Distinguishing consultations from transfers of care
-Ensuring medical necessity for use of Erythropoiesis-Stimulating Agents
-Ordering diagnostic tests
-Responding to government inquiries
-Evaluating encounters for PQRI
-Improving compliance with inpatient-only rule and with transfers and discharges
-Reviewing contracts and documents for Stark compliance
-Creating a document retention policy
-And much, much more!

Table of Contents
Chapter 1: Medicare Coding and Billing Issues
- Risk Areas - Error Prevention - ICD-10 Implementation
Chapter 2: Payment and Reimbursement Issues
Medical Necessity - Observation vs. Inpatient Admission - Payment for HACs, Never Events and Other Medical Errors - Overpayments - High-Dollar Cases
Chapter 3: Documentation
Standing Orders - Physician Signatures - Physician Queries - Documentation Clarity - Diagnostic Testing
Chapter 4: Recovery Audit Contractors and Other Audit Areas
Federal Guidelines for RACs - Audit Strategies - RAC High-Risk and Target Areas
Chapter 5: Compliance Processes and Administrative Strategies
Admissions Procedures, Including EMTALA - Gifts and Entertainment - Case-Management Protocol - Disclosure and Transparency - Electronic Health Records - Quality Initiatives - Tools and Technology - Training and Education Provider / Pharmaceutical Relationships - Attorney-Client Privilege
Chapter 6: Fraud and Abuse, False Claims
False Claims Act - Durable Medical Equipment Fraud and Abuse - Federal Fraud Oversight and Legislative Efforts - Judgments and Settlements
Chapter 7: Anti-Kickback and Stark Physician Self-Referral Laws
Stark Federal Guidance - Strategies for Complying With Stark - Stark Violations and Enforcement - Gainsharing Arrangements - Anti-Kickback Statute
Chapter 8: OIG Audits and Settlements
Audits - Rulings, Opinions and Guidance - Settlements and Recoveries
Chapter 9: Patient Privacy and Data Security
Safeguarding PHI - Patient Records Breaches - EHRs and Other Data Security Issues - Federal and State Laws and Regulations - Security Breach Notification Laws - FTC Red Flag Rule - Identity Theft Breaches and Strategies - Lawsuits, Settlements and Covered Entities - HIPAA and Law Enforcement - HIPAA s Impact on Research - Other Strategies for HIPAA Covered Entities
Appendices:
The Seven Elements of a Compliance Program - OIG Supplemental Compliance Program Guidance for Hospitals - OIG Compliance Program Guidance for Hospitals