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Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.1 This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented by the U.S. Department of Labor’s Employment & Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U.S. Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, non- commercial use only.
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Compliance Compliance Program Office of Inspector General (OIG) for the Dept. of Health and Human Services Compliance programs are required for any entity that bills the federal government for medical services
Compliance Plan Healthcare organization’s plan to adhere to and monitor adherence to all laws and regulations
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Healthcare organizations must abide by local, state, and federal rules & regulations Local safety & building codes State employment and Medicaid rules Federal laws OSHA safety regulations Medicare Billing regulations Federal Fair Trade practices Others
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Anti-kickback Law This law prohibits knowingly and willfully offering anything of value in return for inducing or referring service to a laboratory. See pages 340-343 Examples: 1. Phleb placed by lab in physician’s office cannot do work normally done by office staff 2. No free gloves, no free biohazard waste pick-up 3. Hospital cannot provide “free” physicals to Medicare recipients
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Stark Law (Federal) This law forbids a physician from referring his patients to a laboratory in which the physician or an immediate family member has a financial interest.
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 False Claims Act This law prohibits knowingly presenting a false claim to the government. This law prohibits changing the billing code (upcoding) to increase reimbursement.
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Civil Monetary Penalties Laws (apply to test never performed) These laws prohibit claims for service not provided as claimed. The only way this affects a phlebotomist is that you are responsible for making sure that an order is cancelled if the specimen is never drawn.
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Compliance Plan The laboratory should have a compliance plan to ensure that they are not outside the law in any of their policies, which relate to the laws that we just discussed. As an employee, you will be required to read and understand the lab’s compliance plan.
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Health Insurance Portability and Accountability Act (HIPAA) The original intent of this law was to protect health insurance coverage for workers and their families when they change or lost their jobs. (COBRA) The portion of this act that affects all phlebotomists is the portion that restricts the dissemination of health information on a patient.
Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 HIPAA The patient has the right to privacy as related to health information PHI = protected health information As a healthcare worker, you may not provide health information to anyone other than the ordering physician All hospitals will have policies regarding the release of information, follow these CAREFULLY! Medical Records Department govern the release of all PHI in all medical facilities.
Follow Policies and Procedures CAREFULLY!!
H = P = A = HIPAA DEFINED HIPAA … A Federal Law Created in 1996 Health
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