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"The Federal Anti-Kickback Statute and Safe Harbors is a comprehensive reference book for one of the nation's most commonly cited, investigated and enforced health care fraud and abuse laws. The book offers practical guidance to health care attorneys in understanding the law's origin, purpose and requirements"--
"This book was written to assist and clearly define the Anti-Kickback Statute (AKS), and the criminal laws it covers. These laws state some, and is not limited to, the following: Whoever knowingly and willfully solicits or receives, or offers or pays (including any kickback, bribe, or rebate), for any remuneration directly or indirectly, overtly or covertly, in cash or in kind, in return for being involved in illegal receipt of payments made under the Federal health care program"--
The tools and information you need to lead a comprehensive compliance program. This revised edition is packed with even more practical tools, case studies, tips and tools, sample audits, and sample policies and procedures to help you construct a comprehensive program and meet new regulatory and industry requirements. All of these tools and strategies have been created, tested, and proven by professionals in the field.
Stark Law, Second Edition: A User's Guide to Achieving Compliance Penalties for violations can include $15,000 per claim--and you can be fined for even unintentional violations. Further consequences involve potential exclusion from participation in Medicare, Medicaid, and other federal health care programs.It's tough to simplify a complex rule. Here's help. You will be well equipped to protect your organization from the severe consequences of Stark Law violations with the practical analytical tools and explanations provided in "Stark Law: A User's Guide to Achieving Compliance, Second Edition. " This updated version of HCPro's Stark Law best seller, first published in 2005--and now co-authored by former CMS Stark Law regulator, Lisa Ohrin--helps health care providers, practitioners, suppliers, and other affected members of the health care industry understand the many recent changes in the Stark Law. It explains each provision of the rule and its practical effect for compliance professionals.There are no compliance shortcuts Since issuing its long-awaited Stark II, Phase III Regulations, CMS proposed and finalized a host of additional regulations, notices, and clarifications, including a major final rulemaking in August 2008. The number and speed of these changes add yet another layer to the already complex web of rules and regulations governing Stark Law compliance. Your copy of "Stark Law: A User's Guide to Achieving Compliance, Second Edition, " delivers: A thorough explanation of how the 2007 and 2008 regulations impact the Law as a whole, as well as your organization Access to a comprehensive outline of the entire Law in one location, from the initial proposed regulations through the most recent updates Scores of easy-to-understand case studies, which illustrate the application of the Law A searchable CD-ROM to help you find specific citations Take a look at the Table of Contents: Chapter 1: Background and Analytical Framework Chapter 2: Definitions Chapter 3: Designated Health Services Chapter 4: Referrals Chapter 5: Financial Relationships Chapter 6: All-Purpose Exceptions Chapter 7: Ownership Interest Exceptions Chapter 8: Direct Compensation Exception Chapter 9: Indirect Compensation Arrangements Exception Chapter 10: Exceptions for Physician Recruitment and Retention Payments in Underserved Areas Chapter 11: Period of Disallowance, Temporary Noncompliance, and Technical Noncompliance Chapter 12: Sanctions, Collateral Consequences, and Reporting Requirements Chapter 13: Advisory Opinions With such high stakes, your organization needs "Stark Law: A User's Guide to Achieving Compliance, Second Edition, " to remain on top of the recent amendments to the Law.
Learn how the Anti-Kickback Statute protects the healthcare system and beneficiaries from the influence of money on referral decisions.
While the vast majority of providers never intend to commit fraud or file false claims, complex procedures, changing regulations, and evolving technology make it nearly impossible to avoid billing errors. For example, if you play by HIPAA’s rules, a physician is a provider; however, Medicare requires that the same physician must be referred to as a supplier. Even more troubling is the need to alter claims to meet specific requirements that may conflict with national standards. Far from being a benign issue, differing guidelines can lead to false claims with financial and even criminal implications. Compliance for Coding, Billing & Reimbursement, Second Edition: A Systematic Approach to Developing a Comprehensive Program provides an organized way to deal with the complex coding, billing, and reimbursement (CBR) processes that seem to force providers to choose between being paid and being compliant. Fully revised to account for recent changes and evolving terminology, this unique and accessible resource covers statutorily based programs and contract-based relationships, as well as ways to efficiently handle those situations that do not involve formal relationships. Based on 25 years of direct client consultation and drawing on teaching techniques developed in highly successful workshops, Duane Abbey offers a logical approach to CBR compliance. Designed to facilitate efficient reimbursements that don’t run afoul of laws and regulations, this resource – Addresses the seven key elements promulgated by the OIG for any compliance program Discusses numerous types of compliance issues for all type of healthcare providers Offers access to online resources that provide continually updated information Cuts through the morass of terminology and acronyms with a comprehensive glossary Includes a CD-ROM packed with regulations and information In addition to offering salient information illustrated by case studies, Dr, Abbey provides healthcare providers and administrators, as well as consultants and attorneys, with the mindset and attitude required to meet this very real challenge with savvy, humor, and perseverance.
Burdened with perennially rising costs and responsible for providing health insurance to more than one sixth of all Americans, Medicare in its original form is fiscally and demographically unsustainable. In light of dramatic reforms under the Affordable Care Act (ACA), this book provides a comprehensive overview of the current state of Medicare. Eleanor D. Kinney explains how the ACA addresses systemic problems of cost and volume inflation, quality assurance, and fraud. Recognizing the potential for more radical change in the future, Kinney also explores the potential of Medicare to become a single-payer system. Comparisons are made with national health systems in Canada and the United Kingdom, from which the United States can draw valuable lessons. An approachable yet comprehensive account of Medicare and the ACA, this book will be invaluable for health care professionals and informed citizens.
An accountable care organization (ACO) is a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned group of patients. Accountable Care Organizations: Value Metrics and Capital Formation explores the historical ba