HCCA Compliance 101

  1. Copyright

    HCCA Compliance 101, 4th Edition  | August 2016 

    Copyright © 2016 by the Health Care Compliance Association...

  2. Prologue

    HCCA Compliance 101, 4th Edition  | Author: Debbie Troklus  | August 2016 

    The compliance professional continues on the path of evolution; compliance programs are becoming more advanced, and the rules and regulations keep coming. If you are reading this book, you may be new to the field of compliance. The very first thing you need to know is that you are not alone. With “Compliance Professional” being one of the most sought after professions in the country, many individuals are preparing to enter the field. Let me tell you how I started my career in compliance. I was on vacation in the Great Smoky Mountains late in August 1996, when I received...

  3. 1 What's in a Name?

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    You may have noticed that some organizations have compliance programs, and others have ethics/integrity programs. They are often considered synonymous, but a subtle distinction can be made between the two terms. It is generally thought that the title “compliance program” implies a primary concern with following rules and regulations, whereas the title “integrity program” puts the emphasis on values and doing the right thing. There may be differences in approach and subtleties of content, but there are basic elements common to both compliance and integrity/ethics programs. Those common elements, whatever the title of the program, are the focus of this...

  4. 2 The Seven Essential Elements

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    Policies and procedures help to set the expectations for all employees. The Federal Sentencing Guidelines and all OIG program guidance describe this area as one of the seven elements of an effective compliance program. The first of the prescribed elements calls for “The development and distribution of written standards of conduct, as well as written policies and procedures that promote [a]…commitment to compliance.” These two documents, the standards or code of conduct and the policies and procedures, become the tools with which you can begin to build your compliance program...

  5. 3 Organizational Steps

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    The right culture begins with the Board. The Board is the accountable governing body who has the responsibility for overseeing the fiduciary assets and mission of the organization. Support from the top is very important; there can be no program at all, much less an effective one, without the vision and guidance of the board. It is the board that officially recognizes the need for a compliance program and authorizes its launch and implementation, including the hiring of a Compliance Officer. The Federal Sentencing Guidelines are very clear on the expected board commitment. The first step toward implementation of a...

  6. 4 Tailoring Your Compliance Program

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    The compliance program must be tailored to fit your organization. There is not a “one size fits all” program. As we have discussed, you need commitment from the top that supports your program, financial support including necessary staffing, and a continual assessment of your program. Once you understand the organization’s needs, then fit your plan to the organization. The code of conduct should be the focal point of your program...

  7. 5 Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules

    HCCA Compliance 101, 4th Edition  | Author: Darrell Contreras  | August 2016 

    The Health Insurance Portability and Accountability Act was passed in 1996. The intent of the legislation was to reduce the administrative costs of health care. Although now most commonly associated with the Privacy and Security rules, the HIPAA legislation encompassed several areas of law including the availability, portability and renewability of health insurance, as well as other requirements such as changes to fraud and abuse laws, tax laws, the administrative costs in health care data transmissions and payment transmissions, and the application and enforcement provisions of group health plan regulations...

  8. Epilogue

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    As you know, better than most, compliance professionals must deal with complex and cumbersome laws and regulations on a daily basis. But health care laws and regulations have been around for a long time. Even the False Claims Act, which figures so prominently in today’s discussions about Medicare compliance, dates back to the Civil War. We in health care have always been doing compliance but just didn’t label it as compliance. We have watched compliance as a profession evolve over the years and are approaching compliance in a more formal, systematic way. Many universities are offering degrees that have a...

  9. APPENDIX A | Sample Letters to Vendors

    HCCA Compliance 101, 4th Edition  | August 2016 

    Dear Vendor Colleague:...

  10. APPENDIX B | Sample Non-Retaliation Policy

    HCCA Compliance 101, 4th Edition  | August 2016 

    The University of Louisville School of Medicine has implemented a billing compliance program that promotes the highest standard of ethical and legal conduct. Standards of conduct and procedures for faculty members, residents, and staff are implemented to guide this effort...

  11. APPENDIX C | Sample Policy: Responding to Search Warrants

    HCCA Compliance 101, 4th Edition  | August 2016 

    The university recognizes that the United States government has increased its scrutiny of health care providers by deliberately focusing on practices it considers fraudulent and abusive. It has a number of techniques at its disposal to use when investigating suspected fraudulent activity. Those techniques include grand jury subpoenas, civil investigative demands, civil subpoenas and search warrants. Among these techniques, the use of search warrants has grown in popularity among government investigators for a variety of reasons, thus increasing the likelihood that the university, its Office of Compliance, or other officers may be served with a search warrant. The Fourth Amendment...

  12. APPENDIX D | Sample Compliance Officer Position Job Descriptions

    HCCA Compliance 101, 4th Edition  | August 2016 

    The Compliance Officer provides direction and oversight of the Compliance Program. The Compliance Officer is responsible for identifying and assessing areas of compliance risk for the hospital; communicating the importance of the Compliance Program to the executive management and the Board of Directors; preparing and distributing the written Code of Conduct, setting forth the ethical principles and policies which are the basis of the Compliance Program; developing and implementing education programs addressing compliance and the Code of Conduct; implementing a retaliation-free internal reporting process, including an anonymous telephone reporting system; and collaborating with executive management to effectively incorporate the Compliance...

  13. APPENDIX E | Sample Audit Review Forms

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    ...

  14. APPENDIX F | Sample Confidentiality Statements

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    I understand and agree that, in connection with the performance of my duties as a member of the Compliance Oversight Committee, I will be engaged in activities of a confidential nature, including but not limited to participating in reviews and evaluations of internal examinations, evaluations and self-evaluations of the policies, practices and procedures of this organization. I further understand that, in this capacity, I will be expected to receive and/or to become privy to information of a confidential nature, including, but not limited to, medical records, documents and statistics which go to the issue of physician compliance with policies, procedures,...

  15. APPENDIX G | Sample Compliance Line Information

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    Company ABC COMPLIANCE LINE FACTS...

  16. APPENDIX H | Sample Compliance In-Take Forms

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    CONFIDENTIAL / Attachment A / Policy# 15...

  17. APPENDIX I | Sample HIPAA-PHI Procedure

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    Purpose...

  18. APPENDIX J | Code of Ethics for Health Care Compliance Professionals

    HCCA Compliance 101, 4th Edition  | Authors: Jan Heller, Mark Meaney, Joseph E. Murphy, Jeffrey Oak  | August 2016 

    Health care compliance programs are ultimately judged by how they affect, directly or indirectly, the delivery of health care to the patients, residents, and clients served by the health care industry and, thus, by how they contribute to the well-being of the communities we serve. Those served by the health care industry are particularly vulnerable, and therefore health care compliance professionals (HCCPs) understand that the services we provide require the highest standards of professionalism, integrity, and competence. The following Code of Ethics expresses the profession’s recognition of its responsibilities to the general public, to employers and clients, and to the...

  19. Glossary of Compliance Terms

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    Anti-Kickback Law — Prohibits the solicitation, receiving, offering, or paying of any remuneration directly or indirectly in cash or in kind in exchange...

  20. About the Authors

    HCCA Compliance 101, 4th Edition  | Authors: Debbie Troklus, Sheryl Vacca  | August 2016 

    Debbie Troklus, CHC-F, CCEP-F, CHRC, CHPC, CCEP-I, is Managing Partner, Aegis Compliance and Ethics Center in Chicago, Illinois. She has more than 30 years of experience in the health care industry, and more than 16 of those years have been in the compliance arena. Prior to her joining Aegis Compliance and Ethics Center, she served as the Assistant Vice President for Health Affairs/Compliance for the University of Louisville Health Science Center. In addition, she serves on the Board of Directors for the Health Care Compliance Association and the Advisory Board of the Society of Corporate Compliance and Ethics. She is...