December 2018: Compliance Newsletter

Posted on January 07, 2019

The Emergency Medical Treatment & Labor Act (EMTALA) was enacted in 1986 to make sure that individuals have access to emergency services regardless of their ability to pay.

November 2018: Compliance Newsletter

Posted on November 26, 2018

MSP or Medicare Secondary Payer refers to benefits provided to a beneficiary when Medicare is not the primary insurance. According to CMS, when Medicare began, they were the primary payer except when Worker’s Compensation, Veteran Administration, or Black Lung Benefits were involved.

October 2018: Compliance Newsletter

Posted on November 02, 2018

If you are a covered entity, any person (with the exception of your workforce) or entity who performs a function or an activity that involves the use of or the disclosure of protected health information (PHI) on behalf of your organization would be considered a business associate.

September 2018: Compliance Newsletter

Posted on September 19, 2018

On August 27, 2018, the Office of Inspector General published a request for information seeking input on current provisions that may be acting as barriers to coordinated care or value-based care.

August 2018: Compliance Newsletter

Posted on September 18, 2018

The 340b program allows certain providers to receive manufacture discounts on covered out-patient drugs. These drugs can then be provided to eligible patients.

July 2018: Compliance Newsletter

Posted on July 28, 2018

The use of an Advanced Beneficiary Notice (ABN) remains a source of confusion for many providers. As such, there are still facilities that do not have processes in place to ensure the use of ABN’s. In some cases, ABN’s are not issued at all, or blanket ABN’s are provided for all services; which is a practice that is illegal.

June 2018: Compliance Newsletter

Posted on June 27, 2018

On June 1, the Office of Inspector General (OIG) released its semiannual report to congress. The report covers a six-month period, October 2017 – March 2018. The report highlights accomplishments, participation in Congressional hearings and updates related to oversight activities.

May 2018: Compliance Newsletter

Posted on May 25, 2018

Compliance, quality, and risk have traditionally been areas of confusion. There are so many
areas of crossover it can be difficult to determine the separation between them and in some
cases, there is no separation. This can be especially difficult in facilities that have separate
compliance, quality and risk departments.

April 2018: Compliance Newsletter

Posted on May 03, 2018

The development and implementation of physician contracts can be extremely complicated. When developing these contracts, the Stark Laws and Anti-kickback statutes have to be taken into consideration. The Stark Law was enacted almost 30 years ago and was developed to remove financial motivations for physicians to order unnecessary testing, and to control overall health care costs.

February 2018 Compliance Newsletter

Posted on February 22, 2018

According to Investopedia, marketing is about product, place, price, and promotion. Promo-
tion often includes activities such as offering rewards, discounts, or free products. A search of

the marketing techniques on the internet provides a multitude of advice of how to incentivize

customers. What most people do not realize is that in healthcare many of the common prac-
tice methods of incentivizing customers or inducing referrals is illegal based upon concerns

that the practice could affect both the quality and cost of care.