A Refresher: Observation Services
When tracking patients’ admissions status, identifying services rendered, calculating the number of observation hours, and ensuring accuracy and completeness of medical…
The Importance of the Conditions of Participation for Hospitals
Compliance officers and billing personnel must assist in complying with the Conditions of Participation (CoPs). This article provides a Compliance…
Scrutiny of Medical Errors Increases
The Centers for Medicare & Medicaid Services (CMS) implemented Medicare’s restriction on reimbursement for hospital-acquired conditions (HACs) that are not…
New Charging Guidelines Underscore the Importance of Cooperation and Evidencing Program Effectiveness
A periodic independent audit or evaluation of the compliance program’s effectiveness is critical. This cannot be done credibly by the compliance…
Understanding the Role of an Interim Compliance Officer
Numerous events can trigger the use of an Interim Compliance Officer (ICO). The trick is finding ICO’s that are properly…
Figuring out the Codes: Inpatient Rehabilitation Facilities and the Transfer Policy
Inpatient rehabilitation facilities (IRFs) are hospitals (or subunits of a hospital) that offer intensive rehabilitation services to the inpatient population. The…
Coordinating External Requests for Information in the Compliance Office
The need for organization-wide strategies for coordination of requests for data, records, and patient information has taken higher priority in…
New Compliance Challenge Preparing for OCR Audits
Many health care organizations have placed Health Insurance Portability and Accountability Act (HIPAA) privacy under the compliance officer.  HIPAA security normally is found with…
Hospitals, Contractors, and Data Mining… What’s Next?
The Centers for Medicare & Medicaid Services’ (CMS) contractors use advanced data-analysis tools, such as data mining, to identify potential payment…
Understanding the Complexities of Subsidy Payments for Hospitals
As a response to a variety of recognized needs, such as patient care, teaching, research, and leadership related to hospital…
Forgotten Issues in Physician Arrangements
The article notes that hospitals need to document why a position is medically necessary and why a physician is selected. About…
Ten Tips For Leveraging Your Compliance Committee
Compliance officers have to be both strategic planners and fire fighters, all at the same time. However, senior executives should…