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Weighing the Stark Law Exceptions

Author: Howrey, Linda

Source: Journal of AHIMA

Publication Date: August 2008


Donations of software and services to physicians allowed under the anti-kickback exceptions are meant to spur health IT adoption, but evaluating the potential is a complex exercise for both donor and recipient.

Exceptions to the Stark Law and the anti-kickback statute enable hospital....

Trends to Watch in Home Health Compliance

Author: Abraham, Prinny

Source: Journal of AHIMA

Publication Date: May 2001




The implementation of the Home Health Prospective Payment System (PPS) on October 1, 2001, has presented some unique compliance risks for HIM and billing managers. This article will briefly describe some of the compliance-related issues on the OIG's agenda that are of interest to HIM....

Roundtable Takes on Compliance Challenges

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: July 1999


The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) and the Health Care Compliance Association conducted a one-day joint roundtable on healthcare compliance to gain new insights into the challenges of creating effective compliance programs. The ro....

Physician Self-Referral and Anti-kickback Laws Pose Threats to Development of Community Health Information Networks

Author: Davis Wright Tremaine LLP

Source: External - used with permission

Publication Date: October 02, 2004


[Oct. 2004] Establishing a regional community-based health information organization (RHIO) exchange presents a host of technical, regulatory, financial and practical challenges. Most would agree that in order for the regional health information organization system to be effective, community p....

Meaningful Use Program Faces Audits, Scrutiny

Author: Rhodes, Harry B.

Source: Journal of AHIMA

Publication Date: February 2013



Health information technology systems have supported the administrative functions of healthcare for more than a decade. Historically, these healthcare administrative systems primarily focused on performing fiscal transactions or supporting key ancillary departments. Widespread use of elect....

Limitation on certain physician referrals

Author:

Source: U.S. Code

Publication Date: January 23, 2000

From the U.S. Code Online via GPO Access [wais.access.gpo.gov] [Laws in effect as of January 23, 2000] [Document not affected by Public Laws enacted between January 23, 2000 and December 4, 2001] [CITE: 42USC1395nn] TITLE 42--THE PUBLIC HEALTH AND WELFARE CHAPTER 7--SOCIAL SECURITY SUBCHAPTER XVIII....

Journal Q&A (4/03)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: April 02, 2003

Q: An attorney recently told our facility that we need to retain records for at least 10 years to comply with the False Claims Act (FCA). Our state law only requires seven years. Which takes precedence?

A: The FCA (31 USC§3729–3733) applies to actions, jurisdiction, and procedu....

Journal Q&A (1/98)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: January 02, 1998

Q: I am employed as a coder and am concerned about my potential risk with respect to fraud and abuse charges involving coding practices. Would you advise me to obtain professional liability insurance?

A: If you work for someone else, contact your employer's legal counsel to fi....

Journal Q&A (1/98)

Author: AHIMA Professional Practice Team

Source: AHIMA Q and A

Publication Date: January 02, 1998


Q: I am a coder in a hospital HIM department. I am being pressured to code in a manner I believe to be fraudulent in order to maximize reimbursement and improve the hospital's case mix. What should I do?

A: Always remember to exhaust all avenues for resolving the matter....

Is the FCA Effectively Fighting Healthcare Fraud?

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: May 2002


How effective has the False Claims Act (FCA) been in reducing healthcare fraud? A recent six-month study conducted by New Directions for Policy for Taxpayers Against Fraud sought to determine just that.1 What the study found is that the FCA is very effective in fighting fraud and should not be....

Hard-line Approach to Compliance Pays Off

Author: Morris, Lewis

Source: Journal of AHIMA

Publication Date: May 2001




While the landscape will continue to change, most observers agree that the healthcare industry finds itself in a very different environment from a decade ago. The reasons for the evolution are numerous, but a significant factor has been the growing influence of compliance initiatives....

Governmental Audit Toolkit

Author: AHIMA

Source: AHIMA toolkit

Publication Date: December 02, 2011

This toolkit is designed to provide guidance to HIM professionals on how to prepare for and ensure compliance in managing governmental audits.

GAO Evaluates Implementation of False Claims Act Guidance

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: November 1999


With the increased attention to healthcare fraud and abuse in recent years, the Department of Justice (DOJ) has been using the False Claims Act to prosecute healthcare providers for practices that, in the past, might have been dealt with by seeking repayment. The damages and penalties....

Final Stark II Regulations

Author: Bergeson, Donna; Butler, Jennifer

Source: AHIMA Convention

Publication Date: October 10, 2001


Introduction

The Stark Law1is designed to prohibit physician referrals for certain services when the referring physician has a financial relationship with the facility providing the service. This paper will summarize the history of the Stark Law and provide a brief discussion of the fu....

False Claims

Author:

Source: U.S. Code

Publication Date: January 02, 2002



From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between January 2, 2001 and January 28, 2002]
TITLE 31. MONEY AND FINANCE
SUBTITLE III. FINANCIAL MANAGEMENT

Cost of Fraud

Author:

Source: Journal of AHIMA

Publication Date: January 1999


According to the Department of Justice Health Care Fraud Report for Fiscal Year 1997, $1.2 billion was awarded or negotiated as a result of criminal fines, civil settlements, and judgments in healthcare fraud matters. And $517 million of that amount came from the settlements of three case....

Compliance: A Critical Yet Costly Commitment

Author: Roach, Daniel R.

Source: Journal of AHIMA

Publication Date: May 2001




In the 1970s, the defense budget consumed the largest share of the federal budget. Concerns about both the size and efficiency of the defense bureaucracy triggered a massive crackdown on federal contractors who had either intentionally or inadvertently failed to follow the Department....

ABNs--Always Been Neglected

Author: Dunn, Rose T

Source: AHIMA community resource

Publication Date: November 14, 2003


For something that has been around for nearly 2 decades and supported by regulation since 1965, Advance Beneficiary Notices (ABNs) continue to cause headaches today. The use of written notices has been available since the enactment of PL 92-603 in 1972. The specific format called an Advance B....

2003 Red Book Reveals Cost-saving Recommendations

Author: Prophet-Bowman, Sue

Source: Journal of AHIMA

Publication Date: September 2003


Although the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has already saved tax payers more than $12 million this year, it offers still more cost-saving recommendations for the Centers for Medicare & Medicaid Services (CMS) in its annual Red Book that hav....