Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Audience:

Business Partners
Hospitals and Other Providers

Career level:

Early Careerist
Experienced Professional
Student

Recommended for:

Billing
Medical Records

Advance Preparation:

None

Prerequisites:

None

Course Availability:

18 Months

Course | Overview | Compliance

Compl: Healthcare Industry Regulation and Accreditation

Course | Overview | Compliance

Compl: Healthcare Industry Regulation and Accreditation

Description

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).
After this program, you'll be able to..
  • Recognize changes in the focus of healthcare regulation over the last 20 years
  • Recognize recent efforts by CMS to monitor and recover improper reimbursement
  • Provide a general description of The Joint Commission
  • Identify the several types of organizations for which The Joint Commission provides evaluation and accreditation services
  • Recognize why the HMO Act of 1973 was deemed necessary
  • Name some of the financial guidelines established by the HMO Act of 1973
  • Recognize the National Association of Insurance Commissioners HMO Examination Handbook
  • Identify some types of state regulations that deal with HMO solvency
  • Recognize why ERISA was deemed necessary
  • Identify the types of organizations and health benefit issues that are governed by ERISA
  • Recognize how ERISA may preempt state regulations
  • Recognize why prompt payment regulations were deemed necessary
  • Provide a general description of prompt payment regulations
  • Identify the types of organizations that are exempt from prompt payment regulations
  • Recognize why COBRA was deemed necessary
  • Recognize the regulations established by COBRA
  • Recognize the purpose of EMTALA
  • Identify the actions required by hospitals to be in compliance with EMTALA
  • Recognize the purpose of URAC
  • Name several of the accreditation programs offered by URAC
  • Recognize the major provisions of HIPAA
  • List some changes to HIPAA privacy laws included in ARRA
  • Identify the types of information collected and disseminated by HIPDB
  • Recognize changes to HIPDB that were implemented in 2004
  • Briefly define QISMC's standards and guidelines
  • Define EHRs and list information included in them
  • List the two main issues to consider when discussing the safe use of EHRs
  • Recognize the potential results of EHRs' emphasis in providing one standardized clinical data structure and presentation
  • Recognize the purpose of NCQA
  • List and briefly describe the six areas covered by an NCQA review
  • Recognize the purposes of PPACA
  • Identify the major provisions of PPACA

Related Courses | Compliance

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: Compliance and HIPAA Regulations

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 the statutes and regulations that govern all federal programs, and to operate within them. You'll know more about the Health Insurance Portability and Accountability Act (HIPAA), including electronic transaction code sets, and privacy and security components.

Course | Overview | Compliance

Compl: Fraudulent Acts and Other Compliance Risks

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.

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.