Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Delivery Method:

Self Study

Course Availability:

18 Months

Recommended for:

Billing
Claims

Career level:

Early Careerist
Experienced Professional
Student

Audience:

Business Partners
Hospitals and Other Providers

Advance Preparation:

None

Prerequisites:

None
Course | Overview | Compliance

This course covers a set of four compliance risk areas identified by the Office of Inspector General (OIG) that healthcare providers need to be aware of before they submit healthcare claims to federal agencies for approval. The course also ...

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Course | Overview | Compliance

This course provides a general discussion and overview of reimbursement provided by Medicare under the outpatient prospective payment system. It also discusses the use of ambulatory payment classifications in the outpatient prospective paym...

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Course | Overview | Compliance

This course discusses the regulation and accreditation of the healthcare field. It provides overviews of various legislation, such as the HMO Act of 1973, the Employee Retirement Income Security Act of 1974 (ERISA), state regulations, and t...

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Course | Overview | Compliance

This course addresses the rise of corporate compliance programs in healthcare organizations, including their complexity and importance. It reviews the components of corporate compliance programs and the role of a compliance officer to know ...

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Course | Overview | Compliance

This course explains the basics of HIPAA's Privacy Rule and what you need to consider when handling patients' Protected Health Information (PHI). It also outlines the rights that patients have under HIPAA.

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Course | Overview | Compliance

Compl: Fraudulent Acts and Other Compliance Risks

Course | Overview | Compliance

Compl: Fraudulent Acts and Other Compliance Risks

Description

This course defines fraud and abuse as it relates to Medicare and Medicaid. It explains the components of an effective compliance program and describes violations of False Claims regulations and associated penalties. This course explains the key provisions of the Health Insurance Portability and Accountability Act (HIPAA). It explains how a healthcare organization qualifies for tax-exempt status and how such an organization may generate unrelated business income that may be taxable.
After this program, you'll be able to..
  • Identify situations that would be classified as fraud or abuse under the Social Security Act and other legislation
  • Name the most common forms of fraud related to Medicare
  • Recognize the circumstances under which civil monetary penalties (CMP) are imposed
  • List elements that should be included in a compliance program for conformance to the False Claims Act
  • Identify OIG regulations relating to kickbacks, bribes, and rebates
  • List the payment or business practices covered by safe harbors
  • Recognize the HIPAA requirements for standard transactions
  • Recognize the HIPAA requirements for code sets
  • Recognize how a healthcare organization qualifies for tax-exempt status
  • State examples of activities that do and do not generate unrelated business income
  • Identify how to compute unrelated trade or business taxable income
  • Recognize the types of transactions that may create excess benefit for individuals affiliated with tax-exempt organizations
  • Recognize the need for reporting and the costs that are typically included in community benefits
  • Differentiate between uncompensated and charity care

Related Courses | Compliance

Course | Basic | Physician Payment and Reimbursement

PPM: Coding and Payment Systems

This course discusses coding and payment systems, which establish the potential revenue of the physician practice. Other topics include fee schedules and relative value systems as well as compliance and rules for teaching physicians.

Course | Overview | Compliance

Compl: Billing Risks

This course covers a set of four compliance risk areas identified by the Office of Inspector General (OIG) that healthcare providers need to be aware of before they submit healthcare claims to federal agencies for approval. The course also discusses the nature of these risks and the potential sanctions and consequences for healthcare providers if they take these risks while submitting claims to federal agencies.

Course | Overview | Compliance

Compl: The Outpatient Prospective Payment System

This course provides a general discussion and overview of reimbursement provided by Medicare under the outpatient prospective payment system. It also discusses the use of ambulatory payment classifications in the outpatient prospective payment system. The course can be used as a basis for understanding compliance issues relating to the OPPS.

Course | Overview | Compliance

Compl: Healthcare Industry Regulation and Accreditation

This course discusses the regulation and accreditation of the healthcare field. It provides overviews of various legislation, such as the HMO Act of 1973, the Employee Retirement Income Security Act of 1974 (ERISA), state regulations, and the Patient Protection and Affordable Care Act (PPACA). It also discusses regulatory and crediting bodies, including the Joint Commission, URAC, and the National Committee for Quality Assurance (NCQA).