Upon completing this course, you should be able to:
To provide health care professional providers with prevention and intervention of methods to implement, research and store within their place of business and practices.
To start a plan of action to avoid overpayments, overutilization, underutilization, litigations; civil and criminal actions against you. However, you will learn from this book that no protection is 100%, but having the knowledge is of true value.
Prevention Methods is a follow-up from the Provide-2-Protect Book that should receive during or before taking this course.
To equip providers with a basic understanding of fraud and abuse laws at the local, state, and federal levels, allowing them to comply with them more easily alongside other priorities.
The information is conducted on a step-by-step basis but is not intended for legal guidance but to utilize for legal research, procedural and regulatory responsibilities on a consistent basis.
To push providers to avoid healthcare unintentional fraud and abuse activities by keeping a check on activities, such as monitoring a billing clerk who overcharges a customer by assuming the provider performed specific services and other unintentional fraudulent activities.
To help healthcare providers implement a compliance program for better monitoring
To improve billing and other operational processes involved in the business
To help medical providers develop and distribute written conduct policies and standards promoting their commitment to compliance
To enlighten providers on the importance of implementing continuous education and training programs for staff
To motivate providers to address areas of potential fraud, such as financial relationships and claim management
To emphasize the importance of maintaining a process to receive healthcare complaints and fraud reports, such as emails or hotlines.
When you finish the course, you will be able to:
Understand your state and federal laws that govern your place of business, your financial stakeholders, and your consumers.
Place in policies and procedures pertaining to your Medicaid/Medicare and private insurances of your practice accreditations, HR documents, and consumer handbooks.
Learn and practice administrative and appeals procedures within your place of business
Implement Quality Assurance for auditing purposes
Due process procedures for healthcare providers
Implement Fraud, Waste and Abuse Management and Training in the workplace
Implement business meetings and staff meetings of billing procedures in the office
Develop and distribute written conduct standards and policies to promote commitment to compliance
Establish a system through which complainants can register their fraud or abuse complaints
Implement disciplinary actions against staff members violating compliance laws and policies
Investigate and remediate systemic and operational problems for better governance