Never-Event Payment Policies - How Health Plans Are Getting Tough on Preventable Hospital Errors; Implementing 'Medical Homes' to Improve Patient Care and the Bottom Line


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Senators Rockefeller, Hatch and Wyden, and Congressmen Stark, Waxman, Camp and Rangel to Speak at Health Reform Conference July 10-11

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Medicare Part D: Analysis of CMS Rules

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New on AISHealth.com: Upcoming Health Business Meetings & Health Business Job Openings

Hot Products

New
2008 Managed Medicare & Medicaid Factbook

2008 Directory of Health Plans

Pharmacy Benefit Survey Results

Best Sellers
2000-2007 Pharmacy Benefit Trends & Data

HCCA-AIS Medicaid Compliance News

Health Plan Facts Trends and Data 2007-2008

Medicare Part D: Analysis of CMS Rules

PBM Contracting & Transparency Issues and Models

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of products at
AIS Marketplace

New on AISHealth.com: Upcoming Health Business Meetings & Health Business Job Openings

Senators Rockefeller, Hatch and Wyden, and Congressmen Stark, Waxman, Camp and Rangel to Speak at Health Reform Conference July 10-11

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AIS Compliance Marketplace

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49 Steps to Implement Sarbanes-Oxley Best Practices
63 Billing and Coding Strategies for Avoiding Medicare False Claims
A Guide to Auditing and Monitoring HIPAA Privacy Compliance
A Guide to Auditing Health Care Billing Practices
A Guide to Complying With Stark Physician Self-Referral Rules

  HIPAA Patient Privacy Compliance Guide
Medicaid Compliance News
Medicaid Fraud Crackdowns and Compliance
Medicare Part D Compliance News
Part D Appeals & Grievances: Strategies for Minimizing Compliance Risks
Report on Medicare Compliance
Report on Patient Privacy
Report on Research Compliance

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Newsletters

The HCCA-AIS MEDICAID COMPLIANCE NEWS, monthly news and valuable how-to strategies for identifying and reducing the top Medicaid compliance risks. Co-published by the Health Care Compliance Association (HCCA) and AIS. 12 issues annually ($417 per year; HCCA member discount available); subscriptions include print copy and e-mail delivery of the newsletter.
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MEDICARE PART D COMPLIANCE NEWS, news and strategies on implementation and compliance with the Medicare drug benefit — marketing, enrollment, formularies, rebates, claims pricing, and fraud, waste and abuse. 12 issues annually ($467 per year) or 2-month intro ($71 for 2 issues); subscriptions include print copy and e-mail delivery of the newsletter, biweekly "Part D E-Letters" and access to a special Part D Web site for easy access to all original documents.

REPORT ON MEDICARE COMPLIANCE, the industry's top source of news and analysis on Medicare compliance, fraud and abuse, billing errors, and a range of complex compliance issues. Includes unique strategic guidance not available anywhere else ... from the desk of veteran compliance reporter Nina Youngstrom, who has written this newsletter since 1992. 45 issues annually ($628 per year) or 2-month intro ($92 for 8 issues); both include print copy and e-mail delivery.
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REPORT ON PATIENT PRIVACY, practical guidance on the confidentiality of patient information and a wide range of complex issues in your HIPAA compliance. Includes how-to news about risk assessments, the use and disclosure of protected health information, safeguarding PHI, business associates, education and training, audits and compliance reviews, recordkeeping and reporting. 12 issues annually ($403 per year) or 2-month intro ($61); both include print copy and e-mail delivery.
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REPORT ON RESEARCH COMPLIANCE, co-published by the National Council of University Research Administrators (NCURA) and AIS, provides the best information there is to help institutions avoid the negative publicity, financial setbacks, and management problems that compliance requirements can create.12 issues annually, plus weekly e-mail newletters and unlimited access to a password-protected Web site. ($368 for NCURA members, $468 for non-members.)
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Looseleaf Guides

A GUIDE TO AUDITING HEALTH CARE BILLING PRACTICES, step-by-step guidance on one of the most challenging problems in Medicare compliance. The guide addresses how to recognize problems, auditing components of your billing process, auditing your IS billing systems, dealing with special billing problems, and much more. Comprehensive looseleaf with quarterly updates and monthly news summaries. ($397 annually).
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A GUIDE TO COMPLYING WITH STARK PHYSICIAN SELF-REFERRAL RULES is a comprehensive looseleaf service written by a team of experienced health care attorneys. It features easy-to-follow explanations of the prohibitions and exceptions under the Stark rules, chapters devoted to the special Stark interests of different stakeholders, summaries of Stark Advisory Opinions issued by the OIG, and copies of regulations and other formal documents. Subscription includes quarterly updates and news summaries (in print and CD formats). ($511 annually).
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HIPAA PATIENT PRIVACY COMPLIANCE GUIDE contains practical guidance and how-to tools from many of the nation’s top HIPAA advisers and practitioners. This looseleaf guide identifies 14 of the most complex and troublesome areas of your HIPAA compliance and addresses each with easy-to-understand summaries of HIPAA requirements and mounds of practical tools – sample forms, notices, waivers, checklists, decision trees, procedures, contract language, timelines, and other practical tools. Comprehensive looseleaf with quarterly updates. ($467 annually).
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Books, Directories & Reports

49 STEPS TO IMPLEMENT SARBANES-OXLEY BEST PRACTICES IN PRIVATE AND NONPROFIT HEALTH CARE ENTITIES, a highly practical book — written by experienced compliance experts at Strategic Management Systems, Inc., led by former HHS Inspector General Richard P. Kusserow — that identifies and describes steps your organization can take to adopt what have become consensus best practice standards for adhering to this landmark corporate responsibility law. Includes a companion CD with templates that can be customized by your organization. ($385)


63 BILLING AND CODING STRATEGIES FOR AVOIDING MEDICARE FALSE CLAIMS is a comprehensive collection of highly practical articles on false claims cases, government billing and coding investigations, and a wide range of Medicare billing and coding problems to avoid. This report will guide you around many of the most common pitfalls in Medicare billing and coding, cost report errors, bad documentation, DRG upcoding, and other problems that can result in enormous fines and penalties against your organization. ($69) PDF version also available via e-mail.


A GUIDE TO AUDITING AND MONITORING HIPAA PRIVACY COMPLIANCE, how-to-do-it guidance on installing effective HIPAA auditing and monitoring systems including practical templates, tools and documents on a companion CD. ($285)
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MEDICAID FRAUD CRACKDOWNS AND COMPLIANCE is packed with case studies that will show you what health organizations should expect under the federal Deficit Reduction Act (DRA).This report explains what sparked the Medicaid enforcement push, how it affects providers and what actions your organization should take now. ($69) PDF version also available.
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PART D APPEALS & GRIEVANCES: STRATEGIES FOR MINIMIZING COMPLIANCE RISKS
examines key issues surrounding Part D appeals and grievances. This report, based on a January 25, 2007, audioconference, shares expert advice on how to structure an effective appeals and grievances procedure — one that will help you avoid becoming a target of CMS enforcement. ($137) PDF version also available.
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Live Meetings & Audioconferences

Meetings are listed below in reverse chronological order,
with the most recent first.

VENDOR GIFTS AND RELATIONS: HOW TO REVISE YOUR HOSPITAL’S STRATEGIES AS THE FEDS CRACK DOWN, a CD of a 90-minute audioconference held on March 25, 2008. Learn how to identify and manage potential vendor gift conflicts, to avoid possible compliance minefields and ensure patient care decisions are not influenced by vendor gift-giving. Speakers are: Donald E. Koenig, Jr., vice president and assistant general counsel of corporate responsibility and enterprise risk management for Catholic Healthcare Partners (CHP) in Cincinnati, and Nickie Braxton, corporate compliance officer for Hartford (Conn.) Hospital/Hartford Health Care Corp. ($329)
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IDENTITY THEFT AND HEALTH CARE: 5 IMMEDIATE STEPS TO TAKE IN THE EVENT OF A SECURITY BREACH, a CD of a 90-minute audioconference held on May 16, 2006. Privacy and data security specialist Reece Hirsch details the steps you can take to limit your liability in the event of a breach, as well as strategies that can help you avoid damaging security breach incidents. ($292)

PART D FRAUD, WASTE & ABUSE: HOW TO COMPLY WITH CMS's APRIL 25 GUIDANCE, a CD of a 90-minute audioconference held on May 11, 2006. Keith M. Korenchuk, a partner in the law firm McGuireWoods LLP, and Debjit A. Ghosh, a senior manager in the Fraud Investigation & Dispute Services branch of the Health Sciences division at Ernst & Young, discuss strategies to help you comply with new CMS requirements for structuring effective FWA compliance programs for Part D. ($292)

THE E-PRESCRIBING 'SAFE HARBORS' AND THEIR IMPACT ON BUSINESS STRATEGIES, a CD of a 90-minute audioconference held on December 1, 2005. Daniel Melvin, Esq., of McDermott Will & Emery LLP, and Mihir H. Patel, Pharm. D., of Horizon Blue Cross Blue Shield of New Jersey, discuss how to design and create effective e-prescribing business strategies that take advantage of HHS’s exceptions to the Stark physician self-referral law and additional anti-kickback safe harbors. ($267)

COMPLIANCE STRATEGIES FOR COMBATING MEDICARE PART D FRAUD, WASTE AND ABUSE, a CD of a two-hour audioconference held on November 10, 2005. Three experts from Gorman Health Group — Michael Flagstad, Jean LeMasurier and Stephen Balcerzak — present strategies you can use to detect fraud, waste and abuse in the Part D drug benefit … and avoid becoming the target of Part D enforcement actions. ($267)

HOW TO AVOID THE 12 BIGGEST HIPAA SECURITY LANDMINES, a CD of a 90-minute program held on March 3, 2005, pinpoints 12 areas that are likely to be among your organization's chief HIPAA security liabilities, with tips and tricks for quickly limiting these risks. Speaker is Chris Apgar, CCISP, a nationally recognized data security and HIPAA expert and principal of Apgar & Associates. ($267)
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HOW TO COMPLY WITH NEW STARK RULES FOR HOSPITALS, PHYSICIANS AND OTHER PROVIDERS, an audiotape of a 90-minute program held on April 15, 2004, helps you understand the new physician self-referral regulations, and identify the pitfalls (and opportunities) that lie ahead for your organization. Speakers are Robert A. Wade, Esq., General Counsel and Organizational Integrity Officer for Saint Joseph Regional Medical Center (SJRMC), in South Bend, Indiana and Robert G. Malkin, Esq., associate in the Washington, D.C. office of Hogan & Hartson L.L.P. and a member of the firm's Health Group. ($267)

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HOW HOSPITALS CAN CONTROL SOARING MEDICARE OUTPATIENT MEDICAL NECESSITY DENIALS, an audiotape of a 90-minute program held on July 16, 2003, explains why medical necessity claims denials are likely to increase dramatically soon, and offers guidance on what steps hospital compliance officers can take to improve their medical-necessity compliance initiatives. Speaker is Darren Carter, MD, President and CEO of Provistas, a Manhattan-based medical coding consulting firm.($267)

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THE IMPACT OF SARBANES-OXLEY ON PRIVATE OR NONPROFIT HEALTH CARE ORGANIZATIONS, an audiotape of a 90-minute program held on June 18, 2003, explains why 2002's revolutionary corporate responsibility law is important to all health care organizations — public, private or nonprofit — and offers expert guidance on the steps these entities should take to comply with many Sarbanes-Oxley provisions. Speakers are Richard P. Kusserow, former Inspector General of HHS, and President of Strategic Management Systems, Inc. (SMSInc.), an Alexandria, Va.-based consulting firm with a strong track record of counseling health care organizations on management and compliance issues, and Frank A. Saputo, Vice President Internal Audit and Chief Compliance Officer for US Oncology, a publicly traded national operator of cancer treatment centers and physician practices. ($267)

 

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