Risk Management and compliance

Fri, 31 Jul 2015 16:34:53 GMT

as I was reviewing this section I did a little internet searching for some additional information to assist in the definitions of risk management and compliance and found the following:

Risk Management is the tool used by management to:

Identify the risks that exist in the provision of health care services;
Understand the scope of those risks; and
Make decisions on how best to address and reduce the risks to a level that the organization can tolerate.

The Risk Management Department often reports to the organization's legal team so that information may be protected and decisions made under the umbrella of that protection.

Corporate Compliance, on the other hand:

Identifies the laws and regulations that govern the provision of healthcare services;
Ensures that the healthcare provider demonstrates substantial compliance with those laws and regulations;
Implements policies, procedures and protocols to facilitate compliance;
Provides training to affected individuals on the policies, procedures and protocols;
Implements disciplinary actions for breaches; and
Reports non-compliance, as necessary, to the authorities.

Sounds easy doesn't it? For those practices that don't have legal teams or compliance departments it falls upon us to make sure we have the appropriate compliance manuals and that the staff and physicians adhere to these policies. It can sound overwhelming but keep in mind we do this every day whether we realize it or not. Most of it becomes second nature to us

One hour of HIPAA compliance training is required for every staff member:

A: Only at the time of initial employment

B: Every six months

C: Once a year

D: Every two years

Answer is C

Go through the above definition of corporate compliance and think about the regulations and laws for each. Stark II--do you know the definition and how it applies to your practice?

review some of those regulations and we will come back with some additional questions to assist

Fri, 31 Jul 2015 16:36:43 GMT

Are there specific areas in compliance that you want more information on? Let us know so we can assist

Fri, 31 Jul 2015 17:26:06 GMT

The law governing physician self-referral for Medicare and Medicaid patients is:

A: Stark
B: HIPAA
C: HITECH
D: Anti-kickback
Answer: A

Stark and anti-kickback can overlap somewhat but are actually two distinctive areas

KICKBACKS are anything of value presented to a practitioner or supplier that may induce that entity to refer health services back to the source of remuneration. Adherence to business relationships based on fair market value transactions will usually negate accusations of the acceptance of kickbacks

STARK LAW
Stark law, actually three separate provisions, governs physician self-referral for Medicare and Medicaid patients. The law is named for United States Congressman Pete Stark, who sponsored the initial bill.
Physician self-referral is the practice of a physician referring a patient to a medical facility in which he has a financial interest, be it ownership, investment, or a structured compensation arrangement. Critics of the practice allege an inherent conflict of interest, given the physician's position to benefit from the referral. They suggest that such arrangements may encourage over-utilization of services, in turn driving up health care costs. In addition, they believe that it would create a captive referral system, which limits competition by other providers. (see physician self-referral

Fri, 31 Jul 2015 17:30:11 GMT

review tip

if you have gone through your resource manual several times--take a few minutes to do some internet searching on the various regulations and compliance issues--- sometimes you can find additional information which puts it in a different format or gives it a different spin and seems to pull it altogether for you.