Third-party biller compliance guidance emphasizes risk awareness.

The voluntary compliance guidance for third-party billing companies released by the HHS Office of Inspector General (OIG) in December 1998, like the OIG's previously released guidance directed at hospitals, home health agencies, and clinical laboratories, identifies seven minimum elements for an effective corporate compliance program: written compliance policies, designation of a compliance officer, ongoing training, open lines of communication, guidelines to ensure the enforcement of compliance standards, internal monitoring and auditing of compliance activity, and procedures to respond to and correct errors. Three areas of concern for third-party billing companies are emphasized in the new guidance document: compliance risk, claims documentation, and disclosure of suspected misconduct or fraud.

The Medicare and Medicaid anti-kickback law: charting your safe harbors.

The Medicare and Medicaid fraud and abuse provisions create many potential pitfalls for physicians; navigating around these problem areas can be tricky. This article discusses recently published federal regulations providing "safe harbors" from the anti-kickback provisions of Medicare and Medicaid law, with particular emphasis on the more common relationships between physicians and hospitals. Those safe harbors that are most and least useful to the physician are highlighted, and advice is offered for evaluating the relative risks involved where no safe harbor is available or fully applicable.

Certificate of need--is group practice next in line?

Certificate of Need agencies are likely to complicate the lives of group practice managers in the future--now is a good time to learn the nature of the beast.