Clinical documentation is the cornerstone for all patient medical records. This information should be of the highest quality to allow for optimal patient outcomes as well as supporting research, medical coding and other uses of the medical record. Its purpose is to adequately relate the patient’s current and historical conditions and treatments with primary focus placed on situations that affect the current medical encounter. It also supports the provider’s defense should the case become a legal issue.
Review of 7 criteria that all entries in the medical record should include
Impact of documentation on coding & claims
Establishing a CDI team
The ICD-10 code set requires explicit documentation of conditions & treatments in order to support the severity of patients under treatment as well as allow for the significant specificity required by this code set. Ambiguous documentation and generic coding will no longer guarantee reimbursement and may generate a claims denial for lack of medical necessity. In this session, we will review the theory of high-quality clinical documentation which has the support of healthcare regulatory guidelines and peer-review research.
Additional consideration involves medical outcomes that may result in legal action. When clinical documentation is vague, missing key elements and conflicting statements, the provider may find that he/she is handicapped in supporting medical decisions and patient results, particularly when the result is a negative outcome for the patient.
In today’s healthcare environment, many patients have become educated consumers of medical services. They are more inclined to request their own medical record, carefully review explanation of benefits from payers, and request a review of any information they deem to be incomplete or questionable.
The session will provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as review the Statute’s available safe harbors. It will also show how violation of the AKS can raise FCA concerns, and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.
We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are. We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law. Since one of the exceptions to enforcement under the Act is regulations promulgated by the Secretary, the “safe harbors,” payment practices that will not be subject to criminal prosecution and that will not provide a basis for civil monetary penalties or exclusion from the Medicare or Medicaid programs, we will examine these safe harbors, particularly those more frequently used, to show how protection from enforcement can be achieved. Specifically, we will review the investment, space and equipment rental, personal services/management contracts, and physician recruitment safe harbors.
In addition, we will discuss the OIG’s Joint Venture Advisory Opinion, where a hospital expands into a related service line by contracting with an existing provider of that service. The OIG has significant problems with such an arrangement. We will also discuss the recent advisory opinion by the OIG regarding Physician-Owned Entities. OIG views PODs as inherently suspect under the AKS because the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the AKS.
Finally, the webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it.
The AKS is currently the focus of law enforcement officials. The Statute provides that the offer or payment, as well as the solicitation or receipt, of “any remuneration” in exchange for referrals of any good, facility, service, or item for which payment may be made in whole or in part under Medicare/Medicaid is prohibited.
Recent cases and/or enforcement actions involving the AKS, violation of which has been held to be the basis of an action under the Federal False Claims Act, (“FCA”) raise serious concerns regarding compliance issues with hospital, physician practices and other healthcare entities. Recoveries under the FCA are at an all-time high, and the percentage of actions involving healthcare organizations has been increasing at exponential rates.
Venue: Recorded Webinar
Imagine the thrill of automating those repetitive Excel tasks that have been draining your productivity. Picture the convenience of effortlessly streamlining complex processes, leaving you with more time to focus on what truly matters. Now, consider the positive impact you can have on your team and clients by offering streamlined, error-free solutions. Excel macros are powerful tools that can transform your Excel experience by automating repetitive tasks, freeing up your time for more important work. If you often find yourself performing the same actions or dealing with time-consuming Excel processes that beg for automation, it's time to dive into the world of macros. In this session, we will explore two methods for creating macros in Excel: The Macro Recorder and The Macro Editor, ensuring you have a comprehensive understanding of both. Objectives By the end of this session, you will have gained proficiency in creating and editing macros using Excel's Macro Recorder and the Macro Editing Tool. Why You Should Attend Mastering macro creation and editing is a crucial skill for advanced Excel users. This knowledge will not only save you valuable time but also benefit your colleagues and clients, as you'll be able to automate various Excel-based tasks and processes. If you've never created macros before, this webinar is for you. Topics covered Best practices for planning your macros Creating macros using the Macro Recorder Saving files as macro-enabled Excel workbooks Executing macros effortlessly Adding a macro-triggering button A comprehensive tour of the Macro Editor Making basic modifications to macros (VBA fundamentals) Leveraging the Personal Macro Workbook to share macros across all your files Who Should Attend? This webinar is designed to kickstart your journey into the world of macros. It's suitable for intermediate-to-advanced Excel users across all industries and job roles. Although we will be using the latest version of Excel for Windows, the majority of the functionalities discussed are applicable to earlier versions of the application as well.
Are you new to Excel and struggling to understand formulas? Are you tired of manually calculating data in Excel spreadsheets? Do you want to learn how to use Excel formulas to streamline your work and save time? If so, this online training session is the perfect solution for you. Think of any scenario that involves addition, subtraction, division or multiplication and that's where you'd use a formula. Once you’ve mastered formulas, you’ll be introduced to functions which are built-in formulas that have been programmed to perform a specific calculation. They can often be used to shorten and simplify what would otherwise be a long-winded manually-entered formula. Why you should attend Excel is an essential tool for anyone who works with data, from entry-level employees to professionals. Knowing how to use Excel formulas can help you streamline your work, increase accuracy, and save time. This training is designed for beginners, so you don't need any prior experience with Excel or formulas to attend. You will leave the session with a solid understanding of the fundamentals of Excel formulas and the confidence to use them in your work. Topics covered Creating basic formulas: addition, subtraction, division, multiplication Using parentheses in formulas - the what and why Copying a formula - the gotchas you need to know about Make formulas logical and understandable by assigning names to your important cells An introduction to functions: SUM, AVERAGE, COUNT and SUBTOTAL The SUMIF and COUNTIF function: Add up and count based on criteria Use TODAY, DATEDIF and NETWORKDAYS to calculate and manipulate dates Use CONCATENATE and TEXTJOIN to combine text from multiple cells Who should attend This training is perfect for beginners who are new to Excel or have limited experience with formulas. Whether you are a student, professional, or simply looking to improve your Excel skills, this training is for you. The training will be delivered using the latest version of Excel for Windows however all of the functionality is also available to users of earlier versions of Excel.
Does your organization consider the strategic, operational, and compliance related impact of human capital decisions on its ability to achieve its business goals and objectives? Does your human capital help your organization achieve its management goals? Are your employment policies and practices creating material risks and liabilities? Are AI issues now affecting your employment practices? This webinar discusses the development and use of HR Audits in answering these questions and in addressing critical risk management and due diligence issues. The threats and risks from human resource management issues are increasing. No longer measured in only fines, penalties, and awards for non-compliance, human resource management affects keys business metrics, including the organization’s valuation and credit rating. Further, improper human resource management can significantly reduce managerial prerogatives and seriously damage the organization’s reputation and employment brand. As a result, HR audits have become an important tool in identifying problem areas and are increasingly evolving from an ad hoc audit activity to a critical element of an organization’s risk management and compliance processes. Numerous external forces and factors have an impact on the demand for and scope of HR audits. First, in the global economy, human capital has become for many organizations the single most important determinant of competitiveness, productivity, sustainability, and profitability. Increasingly, the organization’s human capital is the source of innovation and a driver of business success. Second, a confluence of economic, political, and social factors, including corporate scandals, the failure of organizations to adequately assess risks, and the increasing number of stockholder initiatives, have resulted in increased statutory and regulatory requirements, a call for greater transparency, and increased internal and external audit activity. Third, governmental agencies have become more active — some would argue more aggressive — and have committed more resources to conducting assessments of employment policies and practices. Importantly, the EEOC, the OFCCP, U.S. DOL, and ICE have advised employers that they consider self-assessments and audits a “best practice.” Fourth, AI is no longer used solely as a tool to support HR activities. AI is quickly becoming a critical element of strategic and tactical management activities. It this environment, identifying and assessing human capital related risks have become a critical element of an organization’s success. As a result, an organization’s ability to audit and manage these risks plays an increasing role in helping it succeed. Why You Should Attend HR audits can assist your organization identify the weaknesses and failures of its human resource management and employment practices compliance activities. HR Audits can further help your organization identity critical issues effecting the management of your human capital asset and provide an indication of your organization’s commitment to identifying and ferreting out unlawful practices and processes. Thus, your use of HR audits should consider strategic and tactical issues, identify risks, assess compliance, and develop both quantitative and qualitative methods and measurements to assess those risks. Your HR audit activities should help you assess your organization’s performance and should provide you with data that will allow you to evaluate human capital outcomes. Areas Covered in this Session A discussion of current trends in HR Auditing A discussion of senior management’s HR auditing goals and issues An understanding of the critical components of an HR audit A discussion of economic, political, regulatory, and social factors affecting HR audits A review the use of HR auditing tools A discussion of the development of the HR Audit Scorecard Who will Benefit HR audits and assessments play an increasingly important role in managing an organization. Like other management tools, HR audits help organizations access, manage, and monitor the successes and failures of their use of key resources and help them plan for future requirements. As a result, attendees will gain an understanding of the required elements of improving their organization’s performance. HR professionals Internal and external auditors Business owners Compliance managers Risk managers CEOs CFOs Topic Background HR audits HR auditing HR risk assessments HR compliance
Critical Access Hospitals (CAHs) must comply with the Centers for Medicare & Medicaid Services’ Conditions of Participation located in Appendix W in the manual. This eight-part webinar series will cover the CAH CoP manual. There were changes and new regulations for CAHs in 2020, including a change to all the tag numbers, some which do not include Interpretive Guidelines or Survey Procedures. Changes include infection prevention and control and antibiotic stewardship, QAPI and Swing Bed changes. This seminar will help CAHs comply with specific CoP problem areas, such as nursing care plans, necessary policies and procedures, medication administration and drug storage, and informed consent to name a few. Part Four of Eight: Governing Board, Agreements and Contracted Services, QAPI, Discharge Planning Objectives Describe that CMS requires the Board enter into a written agreement for telemedicine services Describe requirements for contract management for a CAH Describe the essential elements of a QAPI program and Board responsibilities Recall the requirement for when a discharge evaluation must be completed Organizational Structure and Governing Body/Individual Governing body/Individual’s responsibilities Appointment to medical staff Telemedicine services and requirements Required disclosures Agreements and Contracted Services Agreement with providers or suppliers Lab and diagnostic services Food services Quality Assurance Performance Improvement - QAPI Changes to the QAPI program Requirements of a QAPI program QAPI standards Data collection and analysis Reference: Standards and guidelines for Acute hospitals Discharge Planning Need for effective discharge planning process Discharge evaluation and plan Review of discharge planning process Requirement to assist in PAC selection Appendix and Resources