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HEADLINES
Thursday, May 15, 2008

CCH® Health Care Compliance Integrated Library
The Health Care Compliance Integrated Library delivers the latest information on health law. The Library includes seven invaluable titles:
  • Civil False Claims and Qui Tam Actions - An essential tool for bringing or defending Qui Tam action.
  • Clinical Research Compliance Manual: An Administrative Guide - Essential guidance on the laws and regulations affecting clinical research and trials.
  • Defending and Preventing Health Care Fraud and Abuse Cases: An Attorney's Guide - Clear, expert guidance on protecting against charges of health care fraud and abuse.
  • Health Care Fraud and Abuse Compliance Manual - Giving health care providers a clear perspective on fraud and abuse laws, written in plain-language.
  • Health Law and Compliance Update - Find the latest information on emerging issues. Each section is authored by an expert in the area and includes in-depth analysis of the latest health law and compliance issues.
  • Hospital Contracts Manual - Expert, current know-how in dealing with numerous hospital contract scenarios.
  • Hospital Law Manual - Health Law expertise covering treatment and payment issues in the delivery of health care services.

For more details, contact your sales rep.

Health Care Compliance Integrated Library

Reimbursement Advisor

CCH HIPAA Security Guide

The CCH HIPAA Security Guide quarterly updates for April 2008 also includes:

  • In Chapter I-2, Historical Overview and Context, B. Administrative Simplification—
    • A discussion of a case in which a woman who formerly worked for a counseling center in Oklahoma City was charged with giving individually identifiable health information to two other individuals who sought to use the information in an identity theft scheme.
    • A decision by New York’s highest court that a malpractice plaintiff who puts his or her medical condition at issue must sign an authorization compliant with HIPAA allowing defense counsel to have ex parte contact with a treating physician.
  • In Chapter II-1, A Summary Description of the HIPAA Security Rules, A. Overview—
    • A discussion of disclosure of PHI during judicial proceedings via a protective order. An example of such a protective order is given, as well as exceptions to the general rule.
  • In Chapter II-1, A Summary Description of the HIPAA Security Rules, H. Coordination with Other Personal Health Record Initiatives—
    • Information about the Office of the National Coordinator for Health Information Technology (ONC) and the Agency for Healthcare Research and Quality (AHRQ) efforts to bring together teams from 33 states and Puerto Rico to work on the Privacy and Security Solutions Project.
    • A discussion of a February 2008 proposed rule from the HHS Agency for Healthcare Research and Quality that would establish a process in which health care providers can report medical errors voluntarily without fear of legal liability.
    • Efforts by the HHS America's Health Information Community (AHIC), an HHS advisory group, to develop personalized health care policy recommendations.

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Receivables Report

Journal of Health Care Compliance

The May-June 2008 issue of the Journal of Health Care Compliance included the following feature articles:

  • Government/Industry Roundtable Focuses on Quality of Care Oversight by the Board of Directors, by John Falcetano
    • This article discusses the findings of the December 2007 compliance industry and OIG roundtable on longterm care board of director’s oversight of quality of care.
  • The State of the Anti-Markup Rule Regarding Diagnostic Tests, by Kathy J. Tayon
    • This article takes a closer look at the 2008 Medicare Physician Fee Schedule final rule, which among other things amends 42 C.F.R. Section 414.50 prohibiting the marking up of certain diagnostic tests when billing for these tests.
  • The State of the Anti-Markup Rule Regarding Diagnostic Tests, by Kathy J. Tayon
    • This article takes a closer look at the 2008 Medicare Physician Fee Schedule final rule, which among other things amends 42 C.F.R. Section 414.50 prohibiting the marking up of certain diagnostic tests when billing for these tests.
  • A Structured Approach to Developing an Effective Internal Audit Program for Billing and Coding, by Michael Miscoe
    • This article discusses how to develop and implement an effective coding and billing audit program through the use of a structured four-phased process.

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Headlines

CMS focuses on hospital quality in FY 2009 IPPS proposed rule

CMS continued to demonstrate its commitment to improving the quality of care provided to Medicare beneficiaries in the nation's hospitals by including in the fiscal year (FY) 2009 inpatient prospective payment system Proposed rule several provisions that would strengthen the connection between quality and payment for hospital services by tying reimbursement to improved quality reporting. CMS Press Release, April 14, 2008; Proposed rule, 73 FR 23528, April 30, 2008. Full Story

FCA claim fails against hospital qualified for AMC exception

A group of pediatric cardiologists, a medical school, and a pediatric hospital did not submit false claims to the Medicaid program by violating the prohibition on physician self referral under the Stark law (Social Security Act Section 1877) because they qualified for the academic medical center (AMC) exception. U.S. ex rel. Villafane v. Solinger, W.D. Ky., April 8, 2008, Health Care Compliance Reporter p800,487. Full Story

Revised Form 990 takes disclosure to new levels, experts caution

Filers of the new IRS Form 990 will find "triggers" in many questions on the core form directing them to give more detailed explanations on various schedules, John Salbego, tax senior manager, Reznick Group, told exempt organizations at a forum on the new form sponsored by Arent Fox LLP and the Reznick Group on May 1, 2008, in Washington, D.C. Answering "no" to any of the questions could raise a red flag for the IRS, Joseph A. Rieser, partner, Arent Fox, added. CCH Washington Bureau, May 1, 2008. Full Story

Special focus facility data added to CMS Web site

For the first time, CMS' Nursing Home Compare Web site will list whether a nursing home is or has been on CMS' special focus facility (SFF) list. CMS Press Release, April 24, 2008. Full Story

FTC issues final order in ENH case

The Federal Trade Commission (FTC) has released its final opinion and order in the Evanston Northwestern Hospital (ENH)/Highland Park Hospital (Highland Park) case that was initiated in 2005. FTC Press Release, April 28, 2008. Full Story

IRS examining 2006 nonprofit hospital survey respondents

Some tax-exempt hospitals that responded to a 2006 Internal Revenue Service (IRS) survey about their charitable activities are under examination, according to Stephen Clarke, tax law specialist with the IRS Exempt Organizations (EO) Division. CCH Washington Bureau, April 25, 2008. Full Story
On The Front Lines

Compliance begins at the top: 20 questions and answers about compliance

by Mark D. Olson, Esq., Contributing Editor

A company's "culture" comes directly from its executive suite. The actions of individuals at the top define conduct expected or permitted throughout the organization. If employees look to senior leadership and see excessive personal use of the company's money, nobody should be surprised when others working for the company bend the rules. Full Story
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2008 Medicare Explained
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