Chapter 2 Flashcards
The code of Conduct
-demonstrates the organization’s ethical attitude and its enterprise wide emphasis on compliance
-will need to be tailored to the organization’s culture, business and corporate identity
-provides a process for proper decision making
-managers are encouraged to refer to the code of conduct whenever possible, even including elements or standards into performance reviews
Who must agree and abide by the Code of Conduct
-everyone from the board to volunteers must receive, read, understand and agree
-CIA’s require all employees to attest on an annual basis
Code of Conduct: Content Checklist
-Reflects cultures and values
-written plainly - suggested 8th grade reading level
-translated into other languages as appropriate
-Mentions organizational policies without completely restating them
-Is consistent with company policies and procedures
Code of Conduct and Employees
-all must receive, read and understand
-training should be provided specific to the code
-should attest to it in writing annually
-must be enforced failing and consistently through appropriate discipline
-should understand that noncompliance will bring about discipline
Code of Conduct Purpose
-Represent culture of organization
-summarize specific guidelines to follow
-allow employees to know what’s required of them
-provide process for proper decision making
-confirm employees put standards into everyday practice
-elevate corporate performance in basic business relationships
-confirms the organization upholds and supports proper compliance conduct
Compliance Policies and Procedures
-are specific and address identified areas of risk
-should be integrated into existing policies
-Only thing worse that not having a policy is having a policy and not following it
-make sure they are realistic and measurable
OIG work plan
-released in the fall of each year
-highlights those areas the government will give close attention to in the coming months
-be sure to target those areas and address them in the policy and procedures
What areas do Compliance related policies and procedures exist for?
-Auditing and monitoring
-compliance record retention
-self-disclosure
-regular sanction checks
-specific areas of risk
-Non-retaliation
-Stark/anti-kickback
-HIPAA Privacy and Security
-others
Upcoding
-using a billing code that provides a higher reimbursement rate than the billing code that actually reflects the service furnished
-HIPAA added an additional civil monetary penalty to the OIG sanction authorities for upcoding violations
DRG Creep
practice of billing using a DGR code that provides a higher payment rate than the DRG code that accurately reflects the service furnished to the patient
Civil Monetary Penalties Law (CMPL)
regulations which apply to any claim for an item or service that was not provided as claimed or that was knowingly submitted as false and which provides guidelines for the levying of fines for such offences
Teaching physicians
-effective July 1996 and revised November 2002
-outlines documentation regulations for services provided by residents and teaching physicians
Non-retaliation policy
-should be developed and communicated
-if employees are afraid to bring issues forward a compliance program could not be effective
Government comes knocking
develop policies so that your staff knows what to do if presented with a subpoena, search warrant or if questioned by a government investigator
-cannot tell them what they must do but can tell them what their rights are
Anti-Kickback Statute
-prohibits any knowing and willful conduct involving the solicitation, receipt, offer, or payment of any kind of remuneration in return for referring an individual or for recommending or arranging the purchase, lease or ordering of an item or service that may be wholly or partially paid for under a federal health care program.
-is a criminal statute
