Compliance

Many healthcare organizations are not aware of how critically important it is to screen their employees against ALL state and federal exclusions databases. The OIG is reviewing organizations in ALL federal healthcare programs - this includes Medicare, Medicaid, CHIP, etc. - for those who have employed individuals on ANY exclusions database. Not only must you screen employees on the OIG Exclusions database, but employers are also responsible to check state exclusions databases as well.

Employee Exclusions Screenings Must be High Priority

Many healthcare organizations are not aware of how critically important it is to screen their employees against ALL state and federal exclusions databases. The OIG is reviewing organizations in ALL federal healthcare programs - this includes Medicare, Medicaid, CHIP, etc. - for those who have employed individuals on ANY exclusions database. Not only must you screen employees on the OIG Exclusions database, but employers are also responsible to check state exclusions databases as well.

If your organization performs incident-to services, be sure to perform a periodic review of the rules that govern incident to and then compare them to the practices of your providers to ensure they would pass an audit.  Here are just a few of the guidelines that should be reviewed; however, for additional review,  the CMS guidelines for a quick review:

 

Qualifying Personnel:

How can I make sure new hires have not been in trouble with Medicare?

How can I make sure new hires have not been in trouble with Medicare?

Hardship Discounts

Insurance premiums and deductibles are going up and coverage seems to be going down. Even with ObamaCare, there will be plenty of folks out there without insurance or coverage for certain types of services. The shift, referred to by some as the “rise of the self-paying patient,” is creating nothing shy of a crisis for many healthcare providers.

OSHA Resources (Resource 328)

The Occupational Safety and Health Administration (OSHA) was created to assure safe and healthful working conditions. While generally associated with industrial facilities or construction sites, OSHA rules apply to all employers. See Section F-Compliance of the Behavioral Health MultiBook for more information on OSHA requirements and how to implement those requirements.

Links:

Audit Resources (Resource 302)

Understanding Compliance and audits and being prepared for them can be helpful. Generally, healthcare provdiers need to understand:

OIG Compliance Resources (Resource 298)

The Office of the Inspector General (OIG) is the enforcement division of HHS. Their mission is to figtht waste, fraud, and aubse in Medicare, Medicaid, and 300 plus other HHS programs.

HITECH Securing Data Guidelines

Properly securing data is an important HITECH component. Officially, organizations MUST be aware of the official "Guidance Specifying the Technologies and Methodologies that Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals."

Protected health information (PHI) is rendered unusable, unreadable, or indecipherable to unauthorized individuals if one or more of the following applies:

  1. Valid encryption methods, or
  2. Proper destruction.

DATA IN MOTION

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