Fact Sheet | Legal and Regulatory Compliance
HFMA presents a detailed Summary of the OIG’s federal anti-kickback statute and civil monetary penalty final rule, published in the December 2, 2020, Federal Register.
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Fact Sheet | Legal and Regulatory Compliance
HFMA presents a summary of the final rule updating the regulations implementing the physician self-referral law, published by CMS in the December 2, 2020, Federal Register.
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How To | Legal and Regulatory Compliance
Healthcare organizations participating in the 340B Drug Pricing Program should self-audit of their compliance with the program to ensure its ongoing success and effectiveness.
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Blog | Compliance
Hospitals participating in the 340B Drug Pricing Program could lose access due to payer mix changes stemming from the COVID-19 pandemic unless HHS issues a waiver.
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News | Compliance
New requirements regarding notifications of admissions, discharges and transfers present both a challenge and a strategic opportunities for hospitals.
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News | Medicare Compliance RAC OIG
The HHS Office of Inspector General says a significant rise in high-severity inpatient admissions with no corresponding increase in length of stay indicates a possible pattern of upcoding by hospitals in recent years.
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Fact Sheet | Legal and Regulatory Compliance
HFMA presents a detailed Summary of the OIG’s federal anti-kickback statute and civil monetary penalty final rule, published in the December 2, 2020, Federal Register.
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Fact Sheet | Legal and Regulatory Compliance
HFMA presents a summary of the final rule updating the regulations implementing the physician self-referral law, published by CMS in the December 2, 2020, Federal Register.
Save
How To | Legal and Regulatory Compliance
Healthcare organizations participating in the 340B Drug Pricing Program should self-audit of their compliance with the program to ensure its ongoing success and effectiveness.
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Blog | Legal and Regulatory Compliance
HFMA’s Chad Mulvany says if the CY2021 OPPS rule is finalized as proposed without significant modifications to CMS's MS-DRG weight-setting process, it heightens the need for hospitals to expand outpatient/ASC capacity and continue aggressiv...
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Column | Legal and Regulatory Compliance
Even before the COVID-19 crisis, U.S. healthcare providers faced growing challenges from administrative and regulatory burdens. But the pandemic has these challenges to the point that they mare likely to impose severe financial consequences...
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News | Legal and Regulatory Compliance
The new Stark law and Anti-Kickback Statute changes provide exciting new opportunities to providers to better coordinate care. But with these new opportunities come new areas of compliance that will need to be addressed.
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Fact Sheet | Compliance
HFMA summarized in detail the OIG's proposed rule amending its civil money penalty regulations.
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Blog | Compliance
HFMA's Chad Mulvany reviews some of the U.S. Department of Health & Human Service's changes to the terms and conditions related to the CARES Act Provider Relief Fund.
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Comment Letter | Legal and Regulatory Compliance
HFMA submitted a comment letter to the OIG pertaining to the proposed revisions to safe harbors under the Anti-Kickback Statute, and civil monetary penalty rules regarding beneficiary inducements.
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Comment Letter | Legal and Regulatory Compliance
HFMA submitted a comment letter to CMS pertaining to the physician self-referral regulations proposed rule.
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News | Compliance
Although proposed Stark Law exceptions have drawn praise in comments from many healthcare stakeholders, others see reasons for caution.
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How To | Privacy and HIPAA
While it makes sense to protect patients’ health-specific data, social security numbers and home addresses from external threats, the most significant threats to patient privacy laws are on the inside.
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Podcast | Legal and Regulatory Compliance
The podcast team breaks down the recently issued CMS final rule around price transparency. Also, a rural health system in South Dakota discusses how it transformed its revenue cycle by focusing on self-pay patients.
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Article | Medicare Compliance RAC OIG
BESLER talks about its Transfer DRG revenue recovery service that helps hospitals recover monies they have rightfully earned while maintaining compliance.
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Fact Sheet | Legal and Regulatory Compliance
This document summarizes the proposed rule published by the OIG in the October 17, 2019, Federal Register, to revise safe harbors under the federal anti-kickback statute and the civil monetary penalty law that prohibits inducements offered ...
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Fact Sheet | Legal and Regulatory Compliance
This document summarizes the proposed rule updating regulations implementing the physician self-referral law, published by CMS in the October 17, 2019, Federal Register.
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News | Healthcare Legal
Provider initiatives to better align under value-based payment models would get a boost from proposed Stark and anti-kickback law enforcement changes.
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News | Legal and Regulatory Compliance
HHS has proposed a range of rule changes to anti-fraud laws that providers say have blocked value-based payment arrangements.
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Podcast | Legal and Regulatory Compliance
On the day that public comments were due to CMS on its proposed rule that would require the controversial public release of rates hospitals negotiated with health plans, Joe Fifer, president and CEO of HFMA, and Chad Mulvany, director of he...
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News | Compliance
Despite recommendations for practices to add support personnel to coordinate the care of their frail elderly patients, few small, independent practices employ such staff, new research found.
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News | Compliance
Hospitals supported many of the transparency goals of two proposed healthcare IT rules, but two areas drew sharp concerns.
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Article | Healthcare Legal
Healthcare providers increasingly are being audited for unclaimed property.
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How To | Compliance
Healthcare organizations that qualify as HIPAA covered entities should take five steps when developing a compliance program designed to meet their obligation under HIPAA to safeguard patients’ protected health information.
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How To | Compliance
The potential costs of being found noncompliant with HIPAA are too great for a healthcare provider organization not to have in place a compliance program designed to help safeguard patients’ protected health information.
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Research & Reports | Compliance
Physician real estate agreements are an important focus of a compliance strategy.
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Trend | Compliance
Today’s healthcare organizations face evolving compliance risks that require multidimensional compliance programs focused on promoting greater coordination among all an organization’s functional areas.
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Trend | Compliance
Five evolving areas for compliance require attention from a hospital’s or health system’s compliance program: quality of care, patient abuse, quality reporting, emergency preparedness and case management.
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Q&A | Privacy and HIPAA
What are the HIPAA implications of accessing existing subscriber information in our records for patients who don’t have their insurance information?
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Legislative and Regulatory Update | Privacy and HIPAA
OCR announced 10 important enforcement actions in 2018.
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Blog | Medicaid Compliance
Key things to look for from all stakeholders even though the latest work requirement ruling only applies to the Kentucky and Arkansas cases.
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News | Healthcare Legal
The Trump Administration has shifted its stance on the Texas court case challenging the Affordable Care Act (ACA) now before the Fifth Circuit Court of Appeals.
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Q&A | Legal and Regulatory Compliance
HFMA's expert panel answers questions submitted by Forum members. 
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News | Medicaid Compliance
As many as 17 states could eventually have Medicaid work requirements, which may cut into the finances of hospitals in those states, according to a new analysis.
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Column | Medicare Compliance RAC OIG
Hospitals and health systems should be prepared to see a greater financial impact from Medicare hospital admissions that end with beneficiaries being deceased than from such admissions that end with the patients leaving the hospital in an i...
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Trend | Medicare Compliance RAC OIG
A recent OIG video highlighting various reports offers helpful reminders for finance personnel, compliance officers, legal counsel, and others who assist in ensuring that their healthcare organizations abide by all legal requirements.
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Blog | Compliance
Marty Puranik describes the financial benefits of compliance.
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News | Compliance
Jan. 30—In 2019, the Trump administration plans to implement regulatory overhauls of several administrative barriers to the proliferation of value-based payment, according to a senior administration official.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
CMS reminds healthcare providers that the format for posting is the hospital’s choice, but the information must be “consumer-friendly” and must enable patients to understand their financial liabilities and compare charges for similar servic...
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Legislative and Regulatory Update | Legal and Regulatory Compliance
Legalization of medical marijuana in 46 states raises concerns for hospitals and health systems in terms of administering the drug, patient safety, and staff impact. But sample policies and assistance exist such as three options from the Mi...
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News | Compliance
Jan. 9—Medicare’s $500 million readmissions penalty program may have cut readmissions by only half as much as the half-million that previously was estimated—or not cut them at all, according to new research.
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Tools & Tips | Legal and Regulatory Compliance
Search a compendium of sample policy statements, checklists, and other resources.
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Trend | Legal and Regulatory Compliance
An archive of the Legal & Regulatory Forum's articles, which features our latest content and includes past articles categorized by topic.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
Areas of concern include around transfer agreements and patient status.
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Column | Healthcare Legal
Crowdfunding can increase investor participation and engagement between project initiators and potential funders, as well as raise awareness of neglected health issues.
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Legislative and Regulatory Update | Privacy and HIPAA
Three Boston hospitals that were recently slapped with HIPAA violations for allowing television crews into their facilities are reminders of the intricacies of patient privacy laws. 
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News | Compliance
Oct. 12—An update of Medicare’s overpayments recoupment program isn’t giving providers much hope for change in a system they say unfairly takes and holds their money for long periods, if not for good.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
Recognizing the transition to value-based payment and care coordination, HHS is asking interested parties to identify regulatory obstacles to achievement of that goal.
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Legislative and Regulatory Update | Medicaid Compliance
A government affairs expert shares strategies for keeping up with complex Medicaid rules and stay in compliance.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
A proposal to eliminate required outpatient medical histories and physicals could reduce costs for healthcare providers by $454 annually.
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News | Compliance
Sept. 17—A large portion of the $1.1 billion in ongoing annual regulatory relief proposed this week for providers would come from lower costs for hospital outpatient departments.
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Blog | Medicare Compliance RAC OIG
Mary Kay Thalken explains that ensuring continuity of care to reduce readmissions requires a current, comprehensive referral network. Automating the process can be helpful as well.
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News | Compliance
Aug. 24—Hospitals and their advocates urged specific regulatory changes to the enforcement of federal anti-referral laws, even as some industry stakeholders raised concerns about potential changes.
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News | Medicaid Compliance
Aug. 21—States that broadly exceeded their Medicaid expansion enrollment projections will be among those targeted in recently launched eligibility audits, a senior administration official told Congress this week.
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Executive Roundtable | IRS Compliance
A roundtable discussion about 2017 tax law changes and strategies for optimizing capital structure.
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News | Medicare Compliance RAC OIG
July 12—As Congress gears up to examine statutory changes to the Stark Law next week, the Trump administration is planning to implement changes on an administrative basis.
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Legislative and Regulatory Update | Privacy and HIPAA
While technology changes over the past 22 years have allowed increasingly skillful data breaches, we can expect even more dramatic developments in the next five years. Attention to potential breaches now—in all their various forms—will be e...
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Legislative and Regulatory Update | Privacy and HIPAA
OCR has proposed deregulatory rulemaking to clarify when hospitals may share certain patient behavioral health information.
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Column | Healthcare Legal
Healthcare leaders confronted with the decision to monetize sharing of social media data should consider the impact on all stakeholders, the oath to “first do no harm,” and how technology is used and designed.
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Blog | Medicare Compliance RAC OIG
Dale Schumacher and Fern Nerhood describe how trends in Medicare spending per beneficiary can affect hospital finances.
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News | Compliance
May 8—Although many healthcare issues are calling for congressional action this year, the run-up to the mid-term elections likely will limit legislative advancements to a regulatory relief package, according to a congressional health leader...
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Legislative and Regulatory Update | Red Flags Rule
A U.S. district court judge recently questioned the reasonableness of the claims against BCBS that accuse the health plan of increasing coverage opportunities by eliminating competition.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
A Supreme Court decision affects whistleblowers in for-profit companies; those working for not-for-profits are protected by other statutes.
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News | Compliance
April 6—Providers will start to see new identification cards presented this month by Medicare enrollees, and that may require action steps.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
As lawmakers scrutinize the definition of “charitable” organizations, a recent case involving the timing of taxation of a hospital reclassified as for-profit illustrates the point.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
Two actions that minimize the impact of federal agency guidance documents concern some healthcare experts. Although these changes do not apply directly to healthcare regulatory agencies, government litigators could use them to determine the...
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Trend | IRS Compliance
The Tax Cuts and Jobs Act is likely to have a unique effect on the healthcare industry.
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Legislative and Regulatory Update | Medicaid Compliance
Work requirements present unknown changes and impacts, but the impact may not be as big as some assume. However, what providers and recipients need to consider are the other and seemingly less significant changes that will intensify the ove...
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How To | Privacy and HIPAA
A healthcare thought leader explains how hospitals can generate savings, improve clinical care, and foster physician alignment by participating in BPCI Advanced. 
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Legislative and Regulatory Update | Legal and Regulatory Compliance
Although joint employer status is less likely now in the wake of recent NLRB decisions, hospitals are cautioned to involve labor relations counsel in drafting any subcontracting or outsourcing arrangements. 
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Legislative and Regulatory Update | Legal and Regulatory Compliance
NLRB is requesting public comment on union election regulations. 
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Legislative and Regulatory Update | Privacy and HIPAA
Although a valuable tool for clinical treatment, patient education, and marketing, social media can easily violate hospital legal and ethical confidentiality standards. Seemingly innocent actions such as referring to patient cases or postin...
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Blog | Healthcare Legal
Greg Ford outlines three best practices insurance companies can follow as they prepare for HEDIS reviews.
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Blog | Medicare Compliance RAC OIG
Tim Kelly describes how following a new CMS rule can lead to higher patient satisfaction.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
Healthcare providers can expect an impact in 2018 from changes made by the Trump administration in 2017 that could lead to a decline in the number of Americans with health insurance and an increase in health plans with fewer benefits.
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Blog | Compliance
Stuart J. Schaff and Karin Chernoff Kaplan examine how to improve the negotiating position of hospitals and health systems entering into contracts with physicians, while ensuring compliance.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
With little time until the OPPS final rule goes into effect, finance leaders should take action now to address the key issues that may impact their organizations both financially and operationally.
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Legislative and Regulatory Update | Compliance
In general, compliance professionals are not satisfied with the level of training provided to their boards. A lack of effective training could open organizations up to lawsuits and litigation.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
The strict liability nature of the Stark Law and its many exceptions require legal counsel, healthcare compliance officers, and finance executives to pay scrupulous attention to physician contract details.
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Legislative and Regulatory Update | Legal and Regulatory Compliance
The Stark Law lists designate health services that are targeted to address overutilization.
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How To | Legal and Regulatory Compliance
As 340B drug pricing legislative changes grow, there are proactive steps that rural hospital leaders can take to get the most out of 340B plan participation.
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Blog | Compliance
Rebekah Sharpe describes the pitfalls of noncompliance. 
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Legislative and Regulatory Update | Legal and Regulatory Compliance
The IRS stated that a rural hospital had failed to conduct a proper community health needs assessment and make it widely available to the public. The hospital’s tax-exempt status under section 501(c)(3) was revoked retroactively.
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Q&A | Legal and Regulatory Compliance
Our health system has a new obstetrician/maternity group that it wants to promote on our website and through mailings and e-mail campaigns. Are there any Stark Law or anti-kickback issues that we should be aware of?
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Issue At a Glance | Healthcare Legal
When it comes to staying abreast of changes in health care, nearly 90 percent of healthcare leaders who responded to pulse interview conducted at HFMA’s Annual National Institute (ANI) in June 2017 about changes to government payment and re...
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How To | Privacy and HIPAA
Compliance with credit card security standards has taken on greater importance for hospitals as with the increased likelihood that patients might use credit cards to cover growing payment obligations imposed by high-deductible health plans.
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Trend | Privacy and HIPAA
Healthcare finance leaders should understand that the consequences of noncompliance with the PCI standards for security of credit card information can be severe.
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Trend | Privacy and HIPAA
To comply with HIPAA’s mandate regarding security of information transferred electronically, many organizations have adopted solutions that are not compatible with those of other organizations, making the transfer process cumbersome.
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Trend | Legal and Regulatory Compliance
The TCPA was never intended to prohibit or negatively affect legitimate business-related calls, but that has been the result of court decisions allowing class action lawsuits.
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Blog | Medicare Compliance RAC OIG
Edward Hu, MD, president of the American College of Physician Colleges, offers guidance for physicians seeking to better understand the two-midnight rule.
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Blog | Medicare Compliance RAC OIG
Edward Hu, MD, president of the American College of Physician Colleges, offers guidance for physicians seeking to better understand the two-midnight rule.
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Q&A | Legal and Regulatory Compliance
Are there any policies or workflow processes for handling emergency department patients who misrepresent their identities?
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How To | Legal and Regulatory Compliance
Compliance can become a financial asset. For example, data mining provides opportunities to improve vague or incomplete clinical documentation, weak internal communication, overly conservative or inconsistent coding, and physician education...
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Q&A | Privacy and HIPAA
Are there any special HIPAA considerations when treating children (minors) who are living in group homes?
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Legislative and Regulatory Update | Legal and Regulatory Compliance
Some allied health professionals see state laws as the biggest hindrance.The growing use of team based care continues to run into legal and regulatory hurdles, industry advocates say. Shawn Martin, senior vice president at the American Asso...
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Legislative and Regulatory Update | Legal and Regulatory Compliance
An appellate court ruled hospitals must continue to provide appropriate auxiliary aids to help hearing impaired patients exchange medical and financial information with hospital staff. 
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Blog | Medicare Compliance RAC OIG
Karen Bush discusses strategies to reduce readmissions.
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Blog | Medicare Compliance RAC OIG
Changes announced by the Centers for Medicare & Medicaid Services underscore the need for healthcare organizations to prepare for escalating auditor activity.
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The latest from Washington and across the country on payment, healthcare reform and industry trends.