This course provides an in-depth discussion of important compliance issues for healthcare providers. It is intended primarily for managers and executives, including compliance officers. OIG recommendations for hospital compliance programs and their specific elements are presented. 

The course also focuses on specific fraud and abuse compliance risk areas, particularly risks associated with claims submission. The function and goals of the Medicare Integrity Program and Medicare Recovery Audit Contractors (RACs) are described. Other topics include the roles of the board, executives, and compliance committees as outlined by the OIG. This course also discusses compliance issues related to the inpatient and outpatient PPS, electronic prescribing requirements, the False Claims Act, and Stark requirements.

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  • Describe the structure of a compliance program.
  • Identify and evaluate billing and coding risk areas.
  • Describe activities that are prohibited under the Physician Self-Referral Act (Stark).
  • Explain requirements of the Federal Anti-Kickback Statute.
  • Identify certain areas of vulnerability identified by the OIG.
  • Discuss which federal laws and regulations are enforced by CMS.
  • Explain the risk of billing for services not rendered.
  • Describe how payment is made under the Medicare outpatient prospective payment system.
  • Describe the Anti-kickback and Stark protections relating to the subsidizing of electronic health record systems.
  • Explain the tax implications when a tax exempt organization subsidizes electronic health record systems.
  • Discuss what RACs are and what they do.

HFMA members: $249
Non-members: $299 

Course information:

  • Approximate time to complete: 11 hours
  • Designed for: Executives, managers, compliance professionals
  • Level: Intermediate
  • Instructional method: Self-study
  • Format: Online
  • Program prerequisite: None
  • Advance preparation: None
  • Course availability: One year from start date

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Our ironclad guarantee
HFMA stands behind the quality of our programming. If you are not satisfied, we will gladly refund your money or provide you with a credit certificate toward any future HFMA National educational programs or select products. Contact HFMA directly at 3 Westbrook Corporate Center, Suite 600, Westchester, IL 60154, Attn: Professional Development, or call (800) 252-4362, ext. 2. Please provide HFMA with your comments within two weeks of beginning the program. 

Read additional information about CPEs for CPA licenses and education credits for HFMA certification maintenance.