Learning Objectives:
Upon completing this course, you should be able to:
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To provide health care professional providers with prevention and intervention of methods to implement, research and store within their place of business and practices.
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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.
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Prevention Methods is a follow-up from the Provide-2-Protect Book that should receive during or before taking this course.
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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.
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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.
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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.
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To help healthcare providers implement a compliance program for better monitoring
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To improve billing and other operational processes involved in the business
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To help medical providers develop and distribute written conduct policies and standards promoting their commitment to compliance
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To enlighten providers on the importance of implementing continuous education and training programs for staff
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To motivate providers to address areas of potential fraud, such as financial relationships and claim management
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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:
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Understand your state and federal laws that govern your place of business, your financial stakeholders, and your consumers.
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Place in policies and procedures pertaining to your Medicaid/Medicare and private insurances of your practice accreditations, HR documents, and consumer handbooks.
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Learn and practice administrative and appeals procedures within your place of business
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Implement Quality Assurance for auditing purposes
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Due process procedures for healthcare providers
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Implement Fraud, Waste and Abuse Management and Training in the workplace
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Implement business meetings and staff meetings of billing procedures in the office
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Develop and distribute written conduct standards and policies to promote commitment to compliance
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Establish a system through which complainants can register their fraud or abuse complaints
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Implement disciplinary actions against staff members violating compliance laws and policies
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Investigate and remediate systemic and operational problems for better governance
Course Timeline:
Health care fraud is a sort of white-collar crime that entails making false medical claims to make a profit. Deceitful health-care schemes exist in a variety of shapes and sizes.
At first look, it may appear like physicians and nurses are in charge of a medical facility. They are, after all, the ones who treat and care for the patients. Only the medical providers, on the other hand, genuinely understand and appreciate the value of other employees at a medical institution who work to make doctor visits feasible in the first place.
Quality assurance QA is an essential component of all businesses and organizations, particularly in the healthcare sector. All actions that contribute to identifying, developing, measuring, monitoring, and improving the quality of healthcare can be described as part of it. These actions can be carried out as part of facility accreditation, health worker supervision, or other initiatives to enhance health worker performance and the quality of health services.
Advertisements and legislation protect consumers and beneficiaries of healthcare, but medical providers are rarely supported. Why is it so difficult for a provider to get help and tools to defend themselves? As a result, you must consider protection before it is too late.
The first step towards solving a problem is to recognize that you have one. Medicare and Medicaid programs contributed 1.1 trillion dollars in 2016 to offer health coverage to 145 million Americans, according to a research. Regrettably, fraud and misuse were linked to 95 billion dollars of this amount. According to the FBI, the most severe issue facing the healthcare profession is false billing.
Because you believe you have followed all of the rules in your organization, this issue may seem far-fetched and even absurd. However, because most healthcare workers are overburdened with various responsibilities, you won't be able to safeguard yourself 100 percent. The concern is that you should know how to defend yourself legally if you are ever in this situation. You won't be able to escape legal action, but you can take efforts to protect yourself.
