FACTOIDS
These inappropriate business actions costs tax payers billions of dollars each year.
What is healthcare fraud, waste & abuse.
This policy protects people from retaliation or retribution who report unethical or illegal behavior
Non-retaliation policy. (Whistleblower's Act)
The person to contact at a healthcare facility if you have a compliance concern & name that person at RRC?
Who is the Compliance Officer?
Who is Julie Santos?
You are committing this if you bill for a service that you did not perform.
What is fraud?
Choosing the wrong RP at TOS (by PIC) or not verifying the RP before the exam (by tech) is considered what?
A HIPAA violation.
What is a set of guidelines that outlines ethical behavior for employees.
What is the Code of Conduct?
This makes it illegal for people to submit false statements or documentation in order to collect money from the government- #1 tool for detecting FW&A.
What is the False Claims Act?
Name 1 tool you can use to report compliance issues at RRC?
What is the Compliance Hotline, HIPAA@radiologyregional.com email, compliance@radiologyregional.com email, phone call to compliance officer, email to compliance officer or in person to your supervisor, compliance officer or any member of the compliance committee?
It's a violation of the Compliance Policy to do this when you are aware of fraudulent activity.
What is nothing? (What is to not report it or turn a blind eye?)
Patients are allowed to request this from their medical records.
What is ANYTHING that is in scanned into their account (MDM, PACs, billing).
What is developed by a healthcare facility to set high ethical standards, and because it's mandatory (under the Affordable Care Act) for facilities receiving government payor reimbursement.
What is a Corporate Compliance Program?
This law prevents providers (or their immediate family) who have a financial interest in the practice from referring patients to the practice.
What is the Self-Referral Act or STARK Law.
What are you using/demonstrating when collecting a patient from the waiting room during their scheduled appointment by saying: "Mr. John Doe, I am Vicki and I will be performing your exam today".
What is RRC's rule for treating patients with courtesy and respect using first and last name at initial encounter.
What is the term when a person or vendor is unable to work for any provider receiving government healthcare funds.
What is a Exclusion?
Committing a reportable HIPAA violation could lead to $1,000's in fines and / or jail time?
Yes - Absolutely.
Name 1 of 2 processes are used by healthcare facilities to effectively detect and prevent fraud, waste and abuse.
What are monitoring and audits.
A law that prevents a provider from offering anything of value (such as waiving copays or OOP, cash per patient referral, chairmanships, gifts, travel) for referrals.
What is the Anti-Kickback statute?
Health care facilities offer this monitored compliance reporting method to allow people to report anonymously.
What is a compliance hotline.
Name 1 of the Medicare designated 3 levels of physician supervision requirements and brief description
What is:
GENERAL- under physician authority, not required on site
DIRECT- must be on site during service
PERSONAL-must be in imaging suite during procedure
Who is the Compliance and HIPAA Officer at Radiology Regional?
Julie Santos
Who can be held responsible for healthcare fraud, waste and abuse?
Anyone associated with a claim- providers, vendors, downstream employees and the patients (beneficiaries) themselves.
A law that protects patients and their personal health information.
What is HIPAA?
Who is considered a Covered Entity?
Any physician, healthplan (insurance), or healthcare clearing house (auth) that handles PHI electronically.
The time frame in which a compliance concern must be reported by an employee once they become of aware of it.
What is immediately?
What is the legal retention times for all medical records?
10 years, unless a minor at time of service then 5 years past the age of majority. (age 23)