BP - Health Care Compliance Association

Publisher:
Health Care Compliance Association, 888-580-8373
Executive Editor:
Roy Snell, CEO, roy.snell@hcca-info.org
Contributing Editor:
Gabriel Imperato, JD, CHC, 888-580-8373
Managing Editor/Articles and Advertisements:
Margaret R. Dragon, 781-593-4924, margaret.dragon@hcca-info.org
Communications Editor:
Patricia Mees, CHC, CCEP, 888-580-8373, patricia.mees@hcca-info.org
Layout:
Gary DeVaan, 888-580-8373, gary.devaan@hcca-info.org
HCCA Officers:
Rory Jaffe, MD, MBA, CHC
HCCA President
Executive Director, California Hospital
Patient Safety Organization (CHPSO)
Julene Brown, RN, MSN, BSN, CHC, CPC
HCCA 1st Vice President
Compliance Officer
MeritCare Health System
Jennifer O’Brien, JD, CHC
HCCA 2nd Vice President
Shareholder
Halleland Lewis Nilan & Johnson PA
Urton Anderson, PhD, CCEP
HCCA Treasurer
Chair, Department of Accounting and
Clark W. Thompson Jr. Professor in
Accounting Education
McCombs School of Business
University of Texas
Gabriel Imperato, Esq, CHC
HCCA Secretary
Managing Partner
Broad and Cassel
Shawn Y. DeGroot, CHC-F, CCEP
Non-Officer Board Member of
Executive Committee
Vice President Of Corporate Responsibility
Regional Health
Steven Ortquist, JD, CHC-F, CCEP, CHRC
HCCA Immediate Past President
Partner
Meade & Roach
CEO/Executive Director:
Roy Snell, CHC, CCEP
Health Care Compliance Association
Counsel:
Keith Halleland, Esq.
Halleland Lewis Nilan & Johnson PA
Board of Directors:
Marti Arvin, JD, CHC-F, CPC, CCEP, CHRC
Privacy Officer
University of Louisville
Angelique P. Dorsey, JD, CHRC
Research Compliance Director
MedStar Health
Dave Heller
Chief Ethics & Compliance Officer
Qwest Communications
Joseph Murphy, JD, CCEP
Co-Founder Integrity Interactive
Co-Editor ethikos
Karen A. Murray, MBA, FACHE, CHC, CHA
Corporate Compliance Officer
Yale New Haven Hospital
F. Lisa Murtha, JD, CHC
Managing Director
Huron Consulting Group
Daniel Roach, Esq.
Vice President Compliance and Audit
Catholic Healthcare West
Frank Sheeder, JD, CCEP
Partner
Jones Day
Debbie Troklus, CHC-F, CCEP, CHRC
Assistant Vice President
for Health Affairs/Compliance
University of Louisville
Sheryl Vacca, CHC-F, CCEP, CHRC
Senior Vice President/Chief Compliance
and Audit Officer
University of California
Greg Warner, CHC
Director for Compliance
Mayo Clinic
Compliance Today (CT) (ISSN 1523-8466) is published by the Health Care Compliance
Association (HCCA), 6500 Barrie Road, Suite 250, Minneapolis, MN 55435. Subscription
rate is $295 a year for nonmembers. Periodicals postage-paid at Minneapolis, MN
55435. Postmaster: Send address changes to Compliance Today, 6500 Barrie Road,
Suite 250, Minneapolis, MN 55435. Copyright 2009 Health Care Compliance Association.
All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this
publication may be reproduced, in any form or by any means without prior written consent
of the HCCA. For subscription information and advertising rates, call Margaret Dragon
at 781-593-4924. Send press releases to M. Dragon, PO Box 197, Nahant, MA 01908.
Opinions expressed are not those of this publication or the HCCA. Mention of products and
services does not constitute endorsement. Neither the HCCA nor CT is engaged in rendering
legal or other professional services. If such assistance is needed, readers should consult
professional counsel or other professional advisors for specific legal or ethical questions.
Health Care Compliance Association • 888-580-8373 • www.hcca-info.org
INSIDE
4 New developments in payment and public reporting
of quality of care By Janice Anderson, Cheryl Wagonhurst,
and Anil Shankar
Penalties and incentives are steps toward pay for performance
in Medicare reimbursements.
10 CEU: Unauthorized access to protected health
information: Educating the workforce By Mark C. Rogers
Best practices to implement now to prevent fines, civil
lawsuits, and adverse publicity later.
14 Meet Bill Parke, Vice President, Corporate Compliance,
Rutherford Hospital An interview by Greg Warner
18 Letter from the CEO By Roy Snell
Ethics works if everybody is ethical
21 RAC demonstrations and inpatient rehabilitation—
Vision of things to come? By Jane Snecinski
Documenting “medical necessity” is key to avoiding RAC
denial of payment for inpatient rehab facilities.
25 Ask Leadership By John Falcetano
Red Flag identity theft rules
27 Newly Certified CHCs
28 Physician office compliance—Are you monitoring your
auditing and monitoring program? By Melissa Morales
Opportunities to identify needed changes and corrective
actions may be hiding just out of sight.
32 CEU: Feature focus: Executive compensation in troubled
times—Part 1 By Gerald M. Griffith
Economic pressures, increased transparency, fiduciary duties,
and stakeholder interests make compensation decisions more
than a numbers game.
38 Compliance 101: I just received a subpoena - Now
what? By Andrea Ebreck and Karen Cincione
State and federal privacy laws affect the appropriate response to
requests for protected health information.
40 Go Local
42 Standing at the crossroads By Michael Spake
Combining rules-based compliance with ethical and moral
decisions to form an integrated operations model for excellence.
46 Cyber Doctors By Sonya Burtner
Electronic communications facilitate telemedicine, but also
raise legal and compliance issues.
51 Mandatory Stark reporting: Is a denouement nigh, or
just another chapter in the saga?
By Edwin Rauzi and Lisa Hayward
CMS wants 400 hospitals to respond to its request for information.
53 CEU: Charge Description Master compliance
assessments By Joel W. Lipin
Tips for assessing the accuracy of your CDM.
55 Increased government oversight of managed care
plans— Are you ready? By Steven E. Skwara
Governmental requirements for detecting, investigating,
and reporting fraud and abuse by “downstream” entities.
61 New HCCA Members
3
March 2009