Category: Compliance Effectiveness

LIST OF COMPLIANCE-RELATED POLICIES AND PROCEDURES

PROCESS POLICIES AND PROCEDURES

1. Compliance Program Resolutions
2. Appointment Of Compliance Officer
3. Compliance Plan Document – General
4. Code Of Conduct
5. Statement Of CEO On Compliance
6. Statement Of Board Of Directors
7. Compliance Committee Charter
8. Uniform Compliance Definitions
9. Compliance Plan Elements
10. Compliance Oversight Committee Policy
11. Compliance Office Staff
12. Yearly Compliance Program Review
13. Recommendation Of Additional Policies And Procedures
14. Amendments To Compliance Policies
15. Non-Retaliation And Non-Retribution Policy
16. Excluded Individuals And Entities
17. Compliance Reporting System
18. Compliance Hotline
19. Compliance Training Policy
20. Compliance Reporting To The Board
21. Discipline For Compliance Infractions
22. Compliance As A Performance Factor
23. External Compliance Investigations
24. Execution Of Search Warrants
25. Self-Disclosure And Self-Reporting
26. Compliance Audits, Monitoring And Self-Assessment

RISK AREA POLICIES AND PROCEDURES

Tax – Nonprofit Status

1. Conflict of Interest Policy
2. Whistleblower Policy
3. Board Review of 990 Policy
4. Joint Venture Policy
5. Community Need Assessments
6. Physician Recruitment

Document Control

1. Contract Review and Execution Policy
2. Contract Control System Policy
3. Document Retention Policy
4. Record Management Policy
5. Offsite Storage of Records
6. Destruction of Records
7. Definition of Medical Records

Discharge and Transfer

1. Discharge Planning
2. Transfer to Skilled Nursing Facility
3. Transfer to Hospice

Admissions

1. Admission and Continued Stay Review
2. Readmission Policy
3. Admissions Through Emergency Room
4. Plans of Care

Billing and Coding

1. General Billing and Coding Policy
2. Requests for Coding Changes and Rebilling
3. Changes to Patient Records
4. New and Adjusted Billing Codes
5. Chargemaster
6. E&M Coding
7. Specific Area Coding
   • Anesthesia
   • Radiology
8. Professional Courtesy

Patient Billing and Collections

1. Patient Billing and Collection Policies/Guidelines
2. Billing Inquiries and Audits
3. Reducing a Patient’s Bill
4. Waiver of Co-Insurance and Deductibles
5. Determination of Need and Hardship
6. Referrals to Collections
7. Advance Beneficiary Notices
8. Customer Complaints

Additional Policies

1. Medical Necessity
2. Professional Behavior
3. Disruptive Practitioners
4. Incident Reporting
5. Alleged Caregiver Misconduct
6. Caregiver Background Checks
7. Never Events
8. Physician Compensation
9. Physician Contracting
10. Medical Directorships
11. Leases to Referral Sources
12. Anti-Kickback Policies
13. Stark Law Policies
14. Relationship with Pharmaceutical Representatives
15. Acceptance of Gifts
16. Confidentiality of Information

EMTALA Policies

1. Interfacility Transfers
2. EMTALA Triaging
3. EMTALA – Financial Information
4. Refusal of Delay of Medical Services
5. Emergency Room Coverage
6. Delineation of Roles in Emergency Department
7. Emergency Room Trauma Diversion

Employment Policies

1. Make Consistent with Compliance

Credentialing Policies

Medical Information, HIPAA, Etc.

1. Protection of Patient Health Information
2. Joint Notice of Privacy Practices
3. De-Identification of Protected Health Information
4. Protected Health Information Defined
5. Proposal and Destruction of Protected Health Information
6. Breach Reporting Policies
7. Minimum Necessary Use Policy
8. Permitted and Required Use of Protected Health Information
9. Use and Disclosure of Protected Health Information for Treatment, Payment, Operations
10. Use and Disclosure of Protected Health Information to Family and Others Involved in Care
11. Authorizations for Use and Disclosure with Forms
12. Uses and Disclosures Not Requiring Authorization
13. Uses and Disclosures for Fundraising
14. Uses and Disclosures for Marketing
15. Uses and Disclosures for Research Purposes
16. Recognition of Patient Personal Representatives
17. Business Associates
18. Verifying Identity of Persons Requesting Protected Health Information
19. Patient Right to Access Protected Health Information
20. Denial of Patient Access to Protected Health Information
21. Patient Right to Accounting of Protected Health Information Disclosures
22. Patient Right to Request Designated Record Set
23. Patient Right to Request Alternative Means of Communication
24. Patient Right to Request Restrictions on Use of Protected Health Information
25. Protection of Information Subject to FDA Regulation
26. Protection of Information Subject to AIDS Related Information
27. Protection of Mental Health Treatment Records
28. Psychotherapy Notes
29. Government Requests, Court Orders, Warrants Covering Protected Health Information

Telemedicine Policies

1. Provider Licensure and Credentialing
2. Remote Access Policies
3. Security Policies
4. Telehealth Policies and Procedures
5. Telecommuting Application
6. Telecommuting Agreement
7. Telecommuting Equipment
8. Scheduling Telemedicine Services
9. Emergency Room Consults
10. Billing Telemedicine Service
11. Checklists for Providing Telehealth Services

Technology Policies

1. Passwords, Domains, Local Servers
2. Individual Password Protection
3. Information Security Policies
4. Information Security Incident Process
5. Encryption Policies
6. Physician Access and Restriction Policies
7. Technology Life Cycle Review Policies
8. Technology Disposal Policies
9. Wireless Communication Policy
10. Technology Inventory System
11. Acceptable Use of Computer Equipment
12. Internet Usage Policies
13. Workstation Security
14. Use of Portable Devices
15. E-mail Usage Policies
16. Blogging Policies
17. Social Media Policies
18. Firewall Policy
19. Virus Protection Policy
20. Vendor Credentialing and Access
21. Software Licensing Policies
22. Providing Technology to Referral Sources