COMPLIANCE RESOURCES

Lisa-Ann M. Datu
Arizona State University
HCR 460: Investigations and Disclosures in Health Care Compliance
Professor Marion Richardson
November 27, 2022
 Introduction
It is important for our organization to participate in a compliance program because we have a
legal responsibility to comply with health care laws and regulations like the False Claims Act,
Anti-Kickback Statute and the Stark Law. Failure to comply with these laws can cost our
organization a large amount of money in fines and Civil Monetary Penalties, entering into a CIA,
and facing possible exclusions (Dorfschmid et al, 2021).

This presentation provides eight important resources to help our organization with
Compliance. These resources where chosen because they educate our group on different laws
and regulations. They provide us with tools to help us complete actions like audits, self-
disclosure and confirm exclusions. These resources also provide accreditation via site visit
surveys to show our responsibility. These vendors also provide services to assist us in being
compliant with different health care laws.

These resources should be reviewed regularly so that we are always up to date with any
changes in the law or with any of these programs or tools.
 Resources
 External Governmental Agencies External Governmental Agencies

 External Reviewers/Accrediting • Office for Civil Rights

• Office of Inspector General
Agencies • Center for Medicare and Medicaid Services
 Technology & Legislative Update
External Reviewers/Accrediting Agencies
Vendors
• The Joint Commission
• American Medical Association
• American Society of Transplantation

Technology & Legislative Update Vendors

• Elevate Patient Financial Solutions (formerly

MedData)
• Medscape
 The Office of Inspector General (OIG)
 Governmental Agency that provides compliance oversight to health
care organizations (Troklus & Vacca, 2016, p. 10).

 Access: https://www.oig.hhs.gov/

 How can they help?

 OIG Work Plan/Audits
 Self-Disclosure Tool
 LEIE Online Database
 Corporate Integrity Agreements (CIA)
 The Office for Civil Rights (OCR)
 Governmental Agency that enforces civil rights, HIPAA Privacy Rule,
and HIPAA Security Rule. OCR investigates possible HIPAA violations
and imposes CMP when necessary (Troklus & Vacca, 2016, p.150).

 Access: https://www.hhs.gov/ocr/list-serve/index.html

 How can they help?

 Report or self-report any potential unauthorized access to PHI or medical
records
 Provide guidance on patients’ rights for our employees.
The Center for Medicare and Medicaid Services (CMS)
 Governmental Agency that administers federal health care programs
like Medicare, Medicaid and State Children’s Health Insurance
programs (Troklus & Vacca, 2016, p.141).

 Access:
https://www.cms.gov/Medicare/Coverage/InfoExchange/listserv.html

 How can they help?

 Review their Program Integrity Manual for Facility & Provider Enrollment
requirements
 Review their Medicare Learning Network for program guidance (MLN, n.d.)
 The Joint Commission
 Non-governmental Accrediting Agency. They are a not-for-profit
organization that awards accreditation to health care facilities across the
United States for meeting specified standards (Troklus & Vacca, 2016,
p.150).

 Access: https://www.jcrinc.com/products-and-services/advisory-services/

 How can they help?

 Our organization can apply for accreditation with The Joint Commission which will
greatly help our reputation to patients, job-seekers, and stakeholders
 American Medical Association
 Non-governmental agency that represents physicians in courts across
the nation to confront public health crises. (About, n.d).

 Access: https://www.ama-assn.org/search?search=Regulatory+update

 How can they help?

 Membership provides
 Support in providing facility organizational efficiency
 Increased support for physicians, reduced burnout
 Participation in advocacy discussions (Practice Benefits & Discounts, n.d.)
 American Society of Transplantation
 Non-governmental agency that represents physicians who are interested in
advancing and improving patient care and transplantation through research,
advocacy, organ donation, and community service. (Who We Are, n.d).

 Access: https://www.myast.org/public-policy/legislation-regulatory-updates

 How can they help?

 Membership provides
 Resources to educational material regarding transplantation
 Partnership resources with other committees/groups (myast.org, n.d.)
 Elevate Patient Financial Solutions
 Revenue Cycle vendor service that provides 40 years of revenue cycle
experience combined from organizations including MedData,
RevClaims, and Accounts Receivable Clearing House. (About Us, n.d).

 Access: https://elevatepfs.com/

 How can they help?

 Can process coding & billing claims for our organization.
 Can help us maintain compliance by submitting claims accurately and protecting
our patients’ PHI and medical records.
 Medscape
 Vendor service that provides CME/CE to health care providers. They
always are up to date with the latest medical news and information on
essential drug and disease information. (Who we are, 2022).

 Access: https://www.medscape.com/

 How can they help?

 We can send our providers to Medscape to complete their CME/CE
requirements.
 References
About. (n.d.). American Medical Association. Retrieved November 27, 2022, from https://www.ama-assn.org/about

About us. (n.d.). Elevate Patient Financial Solutions. Retrieved November 27, 2022, from
https://elevatepfs.com/about/

American Society of Transplantation. (n.d.). Retrieved November 27, 2022, from https://www.myast.org/

Dorfschmid, C., Troklus, D., & Vacca S. (2021).  Introduction to healthcare compliance program fundamentals.  In K.L. Kenney (Ed.), Complete
healthcare compliance manual (Vol. 1, pp. 45-50).  Society of Corporate Compliance and Ethics & Health Care Compliance Association.

Practice benefits & discounts. (n.d.). American Medical Association. Retrieved November 27, 2022, from
https://www.ama-assn.org/member-benefits/practice-benefits-discounts

Troklus, D. & Vacca, S. (2016). Compliance 101 (4th ed.). Health Care Compliance Association.

Who we are. (n.d.). American Society of Transplantation. Retrieved November 27, 2022, from https://www.myast.org/about-ast/who-we-are

Who we are. (2022, November 27). Medscape. Retrieved November 27, 2022, from https://www.medscape.com/public/about