Quality of the estimate. December, p. 47 - Health Care Compliance ...

INSIDE
5 The rising tide: Recognizing your criminal
prosecution risks abroad
By Winston Y. Chan and Justin S. Liu
Companies with international third-party
distributors and resellers, consultants, and
foreign clinical trials face high levels of
criminal enforcement scrutiny.
8 CEU: Mail call: How to respond to a
regulatory investigation By K Royal
A step-by-step process for responding to a
complaint notification letter.
12 HCCAnet and Website News
14 Meet Mary Dunaway, Hospital Revenue
Cycle Compliance Director, University of
Arizona Health Network
An interview by Roy Snell
18 Letter from the CEO By Roy Snell
Change
19 Social Networking By John Falcetano
Zone Program Integrity Contractor (ZPIC)
20 Exhale By Shawn DeGroot
Exercise a good sense of humor
23 People on the Move
24 CEU: Losing sleep over health care
marketing arrangements
By Lawrence Conn
Health care providers are faced with
substantial limitations and risk potential
criminal liability for common marketing
efforts, unlike many other industries.
29 Regulatory compliance for research in an
academic medical center
By Jeffrey N. Joyce
Establishing an effective research
infrastructure requires coordination
among many departments to develop and
implement regulatory policies and processes
that work for everyone.
38 CIAs: A look back to the future at OIG
investigations By Jamie L. Kendall
A look at the government agreements with
several pharmaceutical companies may
predict the focus of investigations regarding
sales and marketing tactics.
43 Newly Certified CHC ® ; CHPC ® ; CHRC ®
44 Feature Focus: Medicaid RACs: Tool of
transparency or torment
By Rebecca Jones McKnight
Providers should prepare for greater scrutiny
and view claims and denial data for warning
signs for greater enforcement.
47 Confidence and precision in claims
audits: Quality of the estimate
By Cornelia M. Dorfschmid
Understanding some common auditing
terms will help you determine if an
estimated overpayment amount is
reasonable or should be contested.
51 Accountability is the key to compliance
effectiveness
By Jane A. Obert
An independent review of your compliance
program by an outside consultant may
lead to a culture of continuous quality
improvement.
56 CEU: Compliance 101: Pay now or pay
later By Joyce Freville
Time and effort spent on prevention practices
can pay off better than money spent fixing a
regulatory problem after that fact.
60 How internal controls support compliant
business practices: Part 1
By Kelly Nueske
The five components of internal controls
and how they support “doing it right the
first time.”
68 Documenting fair market value for
physician contracting By Penny Stroud
Using the right tools and knowing what
and when to document can help ensure
your facility is paying comparable rates for
comparable services.
73 New HCCA Members
Health Care Compliance Association • 888-580-8373 • www.hcca-info.org
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December 2011