Documentation requirements
OIG Compliance Program
for Individual and Small Group Physician Practices, Federal Register, Oct. 5, 2000
Provides guidance for individual physicians and small group practices to incorporate
into a medical compliance program
Conflicts of Interest
Conflict of Interest in Medical
Research, Education, and Practice; Chapter 6
Review of physician conflicts of interest along with recommendations
Controlling Conflict of Interest
– Proposals from the Institute of Medicine, New England Journal of Medicine, May
21, 2009
Analysis of the Institute of Medicine's proposals for addressing physician conflicts
of interest
Gifts/Gratuities
Subpart
J-Financial Relationships Between Physicians and Entities Furnishing Designated Health
Services
Electronic Code of Federal Regulations record of section defining improper physician
referrals
Medical Necessity/Advance Beneficiary Notices
Medicare
Claims Processing Manual, Chapter 30
Guidelines for using the Advance Beneficiary Notice of Noncoverage (ABN)
Billing for Services Related
to Voluntary Uses of Advance Beneficiary Notices (ABNs) of Noncoverage
Instructions for use of the GA and GX modifiers
Overpayments/Credit balances
Text of the Patient Protection and Affordable Care Act
Medicare
Overpayment Collection Process
Fact sheet from CMS describing the process it follows to collect overpayments
Certificates of Medical Necessity
Medicare Program Integrity
Manual, Chapter 5
Items and Services Having Special DME Review Considerations
Certification of Home Health/Hospice/Rehabilitative Therapy services
Medicare Benefit Policy
Manual, Chapter 7
Home Health Services
Medicare Benefit Policy
Manual, Chapter 9
Coverage of Hospice Services Under Hospital Insurance
Medicare Benefit Policy
Manual, Chapter 15
Covered Medical and Other Health Services
Medicare General Information,
Eligibility, and Entitlement; Chapter 4
Physician Certification and Recertification of Services
Non-covered services
Advance
Beneficiary Notice of Noncoverage (ABN)
CMS booklet that describes when and how to use the ABN
Teaching physicians
Guidelines
for Teaching Physicians, Interns, and Residents
Documentation and E/M guidelines for teaching physicians, interns, and residents
Medicare Claims Processing
Manual, Chapter 12
Physicians/Nonphysician Practitioners
CMS Manual System, Medicare
Claims Processing, Change Request 3928
Instructions for billing for teaching physician services
Gainsharing Arrangements
Gainsharing
Arrangements and CMPs for Hospital Payments to Physicians
Defines and prohibits gainsharing arrangements from hospitals to physicians to reduce
patient care
Recent Commentary Distorts HHS IG's Gainsharing Bulletin
Rebuttal by the Office of Counsel to the Inspector General against commentary criticizing
the gainsharing bulletin
Joint Ventures
Special
Advisory Bulletin, Contractual Joint Ventures
Bulletin describing and defining questionable contractual arrangements
OIG Special Fraud Alerts
Collection of five special fraud alerts, published in the Federal Register Dec. 19, 1994
Participating/Non-participating agreements
Private Contracting/Opting
out of Medicare
Clarifies policy rules on opt-out status for Medicare
Rental of Office Space
Federal Register, Feb. 24, 2000
Special Fraud Alert: Rental of Space in Physician Offices by Persons or Entities to Which
Physicians Refer
Following established policies/procedures
Keeping
Clean for Compliance, Healthcare Financial Management, June 2005
Discussion of current compliance risks and problem areas for organizations
State escheat laws
The laws vary by state – need to understand general principles of state escheat laws