Complete Healthcare Compliance Manual

Ambulatory Surgery Unit (ASU) Coding and Billing

XYZ

Internal

Q1

50

Inpatient Rehabilitation Facility (IRF)

GHI

Consultant

Q1

50

Facility Emergency Dept. Coding and Billing

XYZ

Internal

Q1

50

SNF RUG Coding

ABC

Consultant

Q2

100

Inpatient Psychiatric Coding

GHI

Consultant

Q2

50

Outpatient Psychiatric Coding

XYZ

Consultant

Q2

50

Facility Emergency Dept. Coding and Billing

ABC

Internal

Q2

50

Ancillary Services Lab

GHI

Consultant

Q2

50

Ancillary Services Pharmacy

XYZ

Consultant

Q2

50

Ancillary Services Respiratory Therapy

ABC

Consultant

Q2

50

Ancillary Services Radiology

GHI

Consultant

Q2

50

Radiology

XYZ

Internal

Q2

50

Inpatient Psychiatric Coding

ABC

Consultant

Q2

50

Clinical Research Billing

ABC

Consultant

Q2

75

Outpatient Chemical Dependence Services

GHI

Internal

Q3

50

ESRD PPS

XYZ

Consultant

Q3

50

Early Intervention

ABC

Internal

Q3

50

Outpatient Mental Health Services

GHI

Internal

Q3

50

Partial Hospitalization

XYZ

Internal

Q3

50

Day Treatment

ABC

Internal

Q3

50

Day Habilitation

GHI

Internal

Q3

50

Follow-up Reviews Home Health

GHI

Internal

Q4

50

Follow-up Reviews Home Health

XYZ

Internal

Q4

50

Follow-up Reviews of Skilled Nursing Facilities

ABC

Internal

Q4

50

Follow-up Reviews of Skilled Nursing Facilities

GHI

Internal

Q4

50

Follow-up Reviews of Hospice

XYZ

Internal

Q4

50

Professional Fee Re-Audits

Various

Internal

Q2

400

Independent Therapists - High Utilization of Outpatient Physical Therapy Services

Various

Consultant

Q2

50

High Volume Providers by Specialty

Various

Consultant

Q2

100

Ophthalmological Services

Various

Internal

Q2

50

Anesthesia Services - Payments for Personally Performed Services (Pain Management)

Various

Consultant

Q2

50

Electrodiagnostic Testing - Cardiology

Various

Internal

Q2

50

Physicians: Impact of Opting Out of Medicare

Various

Internal

Q2

50

E&M Services: Cut & Paste

Various

Internal

Q2

150

Medicaid Rate Part B Carve-Out

Various

Consultant

Q2

50

Extensive OR Procedures Re-Audit

Various

Consultant

Q1

40

Diabetes MS-DRGs 637-639

Various

Internal

Q1

80

Transient Ischemia Attack (TIA) MS-DRG 069

Various

Consultant

Q1

40

Gastroenterology (GI) Bleed MS-DRGs 377-379

Various

Consultant

Q1

40

Syncope

Various

Internal

Q1

80

IV Hydration Units

Various

Internal

Q1

40

Pulmonary Edema and Respiratory Failure MS-DRGs 189/087

Various

Consultant

Q1

40

Excisional Debridement

Various

Consultant

Q1

40

Ultrasound

Various

Internal

Q1

40

Place of Service (POS) Errors in an ASU Setting

Various

Internal

Q1

40

Colonoscopy Units

Various

Internal

Q3

40

Present on Admission (POA) Indicators

Various

Internal

Q3

40

Review Termination Procedures

N/A

Internal

Q2

25

Benchmark Patient Satisfaction Scores Regarding Patient Privacy

N/A

Internal

Q2

30

Employee Conflicts of Interest Audit

N/A

Internal

Q2

25

Audit of the Physician Conflicts of Interest Disclosure Forms

N/A

Internal

Q2

50

Create Additional Conflicts of Interest Procurement Control

N/A

Internal

Q2

10

Review of Physician Practices Coding Procedures

N/A

Internal

Q2

10

Verify Medicare Inpatient Coding Education on New 2021 Codes

N/A

Internal

Q2

10

Electronic Health Record Compliance-Related Policies

N/A

Internal

Q2

50

Review Managed Care Denial Data

N/A

Internal

Q2

10

Professional Fee Data Mining Application

N/A

Internal

Q2

25

Review Professional Fee Denial Data

N/A

Internal

Q2

10

Compliance Integration

N/A

Internal

Q2

10

Review Documentation Related to Physician Administrative Function Contracts

N/A

Internal

Q2

20

Verify Compliance with the On-Call Coverage Payments

N/A

Internal

Q2

20

Verify Compliance with Stark and Anti-Kickback EMR Safe Harbors and Exceptions

N/A

Internal

Q2

10

New HIPAA Rule Implementation

All

Internal

Q1 – Q3

400

Revise Identity Theft Policy and Review Identity Theft Education

N/A

Internal

Q2

25

Implementation of HIPAA Monitoring and Detection Application

N/A

Internal

Q2

100

HIPAA Control for Posting Public and Internal Data on Websites

N/A

Internal

Q2

10

Enhance HIPAA Accounting of Disclosure Process

N/A

Internal

Q2

10

Revision of HIPAA Security Policies

N/A

Internal

Q2

25

Revision of HIPAA Privacy Policies

N/A

Internal

Q2

50

HIPAA Security Training Awareness

N/A

Internal

Q2

50

Verify Appropriate Use of Email with Mental Health Patients

N/A

Internal

Q2

20

Review Facility Directory Privacy Request Process

N/A

Internal

Q2

20

Disposal of Protected Health Information

N/A

Internal

Q2

10

Implement Privacy Control to Protect Texting of Patient Information

N/A

Internal

Q2

10

Implement Additional Training on Protecting Patient Information on Medical Shift Reports

N/A

Internal

Q2

10

Review Sensitive Patient Identifiers on Clinical and Business Forms

N/A

Internal

Q2

40

Identify Additional Training on Medical Identity Theft

N/A

Internal

Q2

20

New Conflicts of Interest Tracking System

N/A

Internal

Q2

30

Review the Gifts and Interactions with Industry Policy

N/A

Internal

Q2

10

Verify Physician Payments Sunshine Reporting Entities

N/A

Internal

Q2

10

Institutional Conflicts of Interest Policy

N/A

Internal

Q2

20

Review Inpatient Federal Health Care Program Denial Data

N/A

Internal

Q2

10

Compliance with New Requirements for Outpatient Physical Therapy Cases

N/A

Internal

Q2

10

Verify Compliance with CMS’ Adverse Event Restraints Regulation

N/A

Internal

Q2

10

Compliance Survey

N/A

Internal

Q2

20

Verify the Implementation of the Revised Physician Education Program for New Physician Employees and Credentialed Physicians

N/A

Internal

Q2

10

Verify the Implementation of the Revised Conflicts of Interest Process for New Physician Employees and Credentialed Physicians

N/A

Internal

Q2

10

Marketing Analysis of Compliance Intranet and Internet Sites

N/A

Internal

Q2

10

Compliance HelpLine Utilization Review

N/A

Internal

Q2

10

Skilled Nursing Facility Compliance Plans

N/A

Internal

Q2

40

New Physician Location Education Roll Out Project

N/A

Internal

Q2

20

Office of Corporate Compliance Documentation

N/A

Internal

Q2

10

Implementation of Health System’s Financial Assistance Program

N/A

Internal

Q2

10

Assist with the Development of a Compliance Managed Care Plan

N/A

Internal

Q2

100

Home Care Network Vendor Agency Exclusion Screening Process

N/A

Internal

Q2

20

Review OIG’s New Exclusion Screening Guidance

N/A

Internal

Q2

20

Review Fair Market Valuation of Physician Compensation

N/A

Internal

Q2

10

Evaluate Compliance Joint Venture Controls

N/A

Internal

Q2

25

Revise Emergency Medical Treatment and Active Labor Act (EMTALA) Policy

N/A

Internal

Q2

10

Electronic Medical Record Access Audit

ABC

Internal

Q1

40

Electronic Medical Record Access Audit

GHI

Internal

Q2

40

Electronic Medical Record Access Audit

XYZ

Internal

Q2

40

Electronic Medical Record Access Audit

ABC

Internal

Q2

40

Electronic Medical Record Access Audit

GHI

Internal

Q3

40

Electronic Medical Record Access Audit

XYZ

Internal

Q3

40

Electronic Medical Record Access Audit

ABC

Internal

Q3

40

Electronic Medical Record Access Audit

GHI

Internal

Q3

40

Electronic Medical Record Access Audit

XYZ

Internal

Q3

160

HIPAA Rounding Audit

ABC

Internal

Q1

15

HIPAA Rounding Audit

GHI

Internal

Q1

15

HIPAA Rounding Audit

XYZ

Internal

Q1

15

HIPAA Rounding Audit

ABC

Internal

Q1

15

HIPAA Rounding Audit

GHI

Internal

Q1

15

HIPAA Rounding Audit

XYZ

Internal

Q1

15

HIPAA Rounding Audit

ABC

Internal

Q1

15

HIPAA Rounding Audit

GHI

Internal

Q1

15

HIPAA Rounding Audit

XYZ

Internal

Q1

15

HIPAA Rounding Audit

ABC

Internal

Q1

15

HIPAA Rounding Audit

GHI

Internal

Q1

15

HIPAA Rounding Audit

XYZ

Internal

Q1

15

HIPAA Rounding Audit

ABC

Internal

Q2

15

HIPAA Rounding Audit

GHI

Internal

Q2

15

HIPAA Rounding Audit

XYZ

Internal

Q2

15

HIPAA Rounding Audit

ABC

Internal

Q2

15

HIPAA Rounding Audit

GHI

Internal

Q2

15

HIPAA Rounding Audit

XYZ

Internal

Q2

15

HIPAA Rounding Audit

ABC

Internal

Q2

15

HIPAA Rounding Audit

GHI

Internal

Q2

15

HIPAA Rounding Audit

XYZ

Internal

Q2

15

HIPAA Rounding Audit

ABC

Internal

Q2

15

HIPAA Rounding Audit

GHI

Internal

Q3

15

HIPAA Rounding Audit

XYZ

Internal

Q3

15

HIPAA Rounding Audit

ABC

Internal

Q3

15

HIPAA Rounding Audit

GHI

Internal

Q3

15

Business Associate Agreement Reviews

XYZ

Internal

Q2 – Q4

100

HIPAA Rounding Audit

ABC

Internal

Q1

15

HIPAA Rounding Audit

GHI

Internal

Q2

15

XXXXX

X. XYZ

Progressing

None.

N/A

XXXXXX

A. ABC

Closed

None.

Corporate Compliance to educate appropriate staff.

XXXXXX

X. XYZ

Field Work

Progressing

None.

N/A

XXXXXX

A. ABC

Field Work

Progressing

None.

N/A

XXXXXX

X. XYZ

Field Work

Progressing

None.

N/A

XXXXXX

A. ABC

Field Work

Progressing

None.

N/A

XXXXXX

X. XYZ

Field Work

Progressing

None.

N/A

XXXXXX

A. ABC

Field Work

Progressing

None.

N/A

XXXXXX

X. XYZ

Field Work

Progressing

None.

N/A

XXXXXX

A. ABC

Field Work

Progressing

None.

N/A

XXXXXX

XX/XX/XX

Open

XX/XX/XX-XX/XX/XX

XXXXXXXXX

XX/XX/XX

Closed

XX/XX/XX-XX/XX/XX

$

XXXXXX

XX/XX/XX

Open

XX/XX/XX-XX/XX/XX

XXXXXXXXX

XX/XX/XX

Closed

XX/XX/XX-XX/XX/XX