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Compliance

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Compliance It is Everyone s Job! What is Compliance? The state of being in accordance with relevant federal or regional authorities and their regulatory requirements. – PowerPoint PPT presentation

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Title: Compliance


1
Compliance
  • It is Everyones Job!

2
What is Compliance?
  • The state of being in accordance with relevant
    federal or regional authorities and their
    regulatory requirements.
  • Most large financial services companies have
    compliance departments that are charged with
    making sure that the company is following all the
    necessary rules and regulations.

3
What is Compliance?
  • Doing the right thing
  • Complying with rules and laws
  • We all have a responsibility to report anything
    that could be considered illegal or unethical

4
Compliance
  • Part of HGA (HealthGroup of Alabama)
  • Compliance Officer _at_ ALH Traci Collins,
    RN
  • Reports to Administration and Board of Directors
  • Gives update to Board annually
  • Chairs Compliance Committee
  • Consist of Administration, Employees, Physician,
    and Board Member

5
Compliance
  • Ensures the facility or company meets the
    requirements for the Department of Justice and
    the OIG (Office of the Inspector General)
  • Written policies, procedures, and standards of
    conduct
  • On-going training program
  • Open communication between Compliance Officer and
    All Staff
  • Internal monitoring and auditing
  • Prompt response to detected offenses and
    corrective action

6
Code of Conduct
  • Confidentiality Patient Relations
  • Fraud and Abuse
  • Filing false claims
  • Incorrect coding
  • Incorrect charging
  • Record Keeping
  • need to know basis
  • Dignity and Respect in the workplace
  • Equal Opportunity Employer
  • Relationships with Vendors Competitors
  • ALH business matters are private
  • Illegal or Questionable Gifts
  • Conflicts of Interest
  • When personal interest differs from the best
    interest of ALH
  • Ex Holding a financial interest in a company
    with whom ALH does business
  • General Laws

7
Computer and Information Usage
  • Respect privacy and rules governing the use of
    any information through the computer system or
    network
  • All access to the system is monitored
  • Do not operate any non-licensed software on the
    computer.

8
E-Mail
  • Always be professional!
  • Do not use email to broadcast confidential
    information
  • Never send user names or passwords via email
  • Follow the same hospital and HIPAA guidelines for
    patient privacy and confidentiality for email
    that you would for any Protected Health
    Information

9
HIPAA
  • Health Insurance Portability and Accountability
    Act
  • Enacted by Congress in 1996
  • Privacy Officer
  • Brenda Moody 256-233-9539
  • Security Officer
  • Kim Hoback 256-233-9117

10
How to Report
  • If you think someone has committed fraud or taken
    a wrong action, please contact
  • Your supervisor
  • Compliance Officer
  • Compliance Hotline

11
Important Numbers
  • Compliance Officer
  • 216-9645
  • HGA Compliance Hotline
  • 1-800-442-0959
  • 1-800-HGA-0959
  • ALL calls are confidential

12
Questions??
  • Presented by Traci Collins, RN
    Compliance Officer

13
ALH Code of Conduct
  • The code of conduct tells how Athens-Limestone
    Hospital employees conduct business. We expect
    everyone to understand and obey the Code of
    Conduct and do their jobs honestly, ethically,
    and legally. If you know about conduct that may
    be illegal or unethical, you must report it to
    your supervisor or to the Health group of Alabama
    alert line number at 1-800-HGA-0959 or to the
    Compliance officer at 256-216-9645. Please be
    aware that calling the alert line can be
    performed anonymously and you will be given a
    code number to follow up with your concern.

14
ALH Code of Conduct
  • STANDARDS
  • Confidentiality and Patient Relations We strive
    to provide quality care to our patient and their
    families. We do not ignore mistakes, and we take
    steps to correct them. We are responsible to
    patients and their families. We treat
    emergencies whether they can pay or not. We do
    not share confidential patient information with
    anyone who does not have a need to know.
  • Fraud and Abuse The law punishes fraud and
    abuse. For example, filing false claims by using
    the wrong billing codes, providing unnecessary
    services, or paying for patient referrals may be
    fraud and abuse. We strive to see that all
    services are medically necessary, are documented
    correctly, and that billing and coding are
    accurate.
  • Record Keeping Athens-Limestone Hospital
    ensures that records are only given to
    individuals with a need to know. The hospital
    does not falsify facts or make false records.
    The hospital maintains appropriate record
    retention policies.

15
ALH Code of Conduct
  • Dignity and Respect in the Workplace
    Athens-Limestone Hospital is an equal opportunity
    employer. We do not allow discrimination based
    on race, creed, color, religion, gender, national
    origin, age, disability, marital status or any
    other legal classification. Sexual harassment is
    strictly prohibited. You as an employee are
    responsible for respecting the rights of your
    co-workers and reporting discrimination to your
    supervisor, or Human Resources, or the Compliance
    Officer at 256-216-9645.
  • Relationships with Competitors, Vendors, Etc.
    Information about Athens-Limestone business such
    as strategy, prices, costs, finances, and similar
    matter is private. You may not discuss
    Athens-Limestone business information with people
    outside Athens-Limestone Hospital.
  • Illegal or questionable gifts We never accept
    bribes or illegal gifts. Only vendors who
    already do business with us can offer gifts, and
    then only small ones. Gifts cannot affect our
    business decisions

16
ALH Code of Conduct
  • Conflicts of Interest A conflict of interest
    happens when your personal interest are different
    from the best interest of Athens-Limestone
    Hospital. You must tell us about all possible
    conflicts of interest. The following examples
    might be conflicts of interest accepting gifts
    or entertainment for another organization,
    holding a financial interest in a company with
    which Athens-Limestone Hospital does business.
  • General Laws You must comply with all laws and
    rules affecting your job, not just the ones
    mentioned here. When in doubt, ask for
    clarification from your supervisor, the
    Compliance Officer, or General Counsel,
  • Athens-Limestone Hospital wants to follow all
    rules and do the right thing both legally and
    ethically. Violations of the Code of Conduct or
    company policy may lead to disciplinary action,
    including termination of employment.

17
Corporate Compliance Receipt and Acknowledgment
  • I have been instructed, received a copy of the
    Code of Conduct, and received a copy of the
    Corporate Compliance material from
    Athens-Limestone Hospital. I understand that I
    am responsible for knowing understanding, and
    following it. If I dont understand something or
    if I have questions, I will ask the appropriate
    person for the answer.
  • Excluded Part Status
  • I affirm that I am not an excluded party from
    participating in Federal health programs, nor am
    I under Investigation which may lead to
    sanctions.
  • Conflict of Interest
  • I affirm that I do not have any conflict of
    interest nor am I aware that any conflicts of
    interest occurring at Athens-Limestone Hospital
  • ______________________________
    __________________________ ___________________
    ____
  • Print Name Signature Date

18
Confidentiality
  • Athens-Limestone Hospital has a firm policy that
    all information concerning a patients diagnosis,
    condition, treatment, and financial status must
    be held strictly confidential.
  • It is my ethical and legal responsibility to
    recognize and protect any information used and
    obtained in the course of my job. Release of
    this information without the patients written
    permission is strictly forbidden by law.
  • I understand that my password(s) is the
    equivalent to my signature. I will not attempt
    to access information using a password other than
    my own or attempt to access information except to
    meet needs specific to my job.

19
Confidentiality
  • I, the undersigned, agree that the consequences
    of a violation of the above statement will result
    in disciplinary that include immediate discharge.
  • ______________________________
    __________________________ ___________________
    ____
  • Print Name Signature Date

20
Personnel Policy Statement
  • My signature confirms that I am not aware of any
    workplace policy violation to include harassment,
    equal opportunity, workplace violence, or
    controlled substances and alcohol abuse. I
    understand that it is my ethical and legal
    responsibility to report any violations of these
    policies.
  • Print Name______________________________
    Signature__________________________
    Date_______________________

21
COMPUTER AND INFORMATION USAGE AGREEMENT FOR
HOSPITAL STAFF
  • Security and confidentiality is a matter of
    concern for all persons who have access to
    Athens-Limestone Hospital Information Systems.
    Each person accessing Athens-Limestone Hospital
    resources and data holds a position of trust
    relative to this information and must recognize
    the responsibilities entrusted in preserving the
    security and confidentiality of this information.
    Therefore, all persons who are authorized to
    access data and resources through information
    systems must read and comply with
    Athens-Limestone Hospital policy.
  • Use of a computer network that is shared by many
    users imposes many obligations in particular
    data, software, and computer capacity have value
    and must be treated accordingly.

22
COMPUTER AND INFORMATION USAGE AGREEMENT FOR
HOSPITAL STAFF
  • As a user of Athens-Limestone Hospital
    Information Systems I will abide by the
    following
  • Respect the privacy and rules governing the use
    of any information accessible through the
    computer system or network and only utilize
    necessary for the performance of my job.
  • Understand that electronic mail is a hospital
    resource and is provided as a business
    communication tool. Employees with legitimate
    business purposes may need to view your
    electronic messages. It is also possible that
    others may view your messages inadvertently.
    Therefore, there is no guarantee of privacy for
    electronic mail.

23
COMPUTER AND INFORMATION USAGE AGREEMENT FOR
HOSPITAL STAFF
  • Respect the ownership of proprietary software.
    For example, do not make unauthorized copies of
    such software for your own use, even when the
    software is not physically protected against
    copying.
  • Respect the finite capabilities of the systems,
    and limit your own use so as not to interfere
    unreasonably with the activity of others.
  • Respect the procedures established to manage the
    use of the system.
  • Prevent unauthorized use of any information in
    files maintained, stored, or processed by
    Athens-Limestone Hospital.

24
COMPUTER AND INFORMATION USAGE AGREEMENT FOR
HOSPITAL STAFF
  • Not seek personal benefit or permit others to
    benefit personally by any confidential
    information or use or equipment available through
    my work assignment.
  • Not operate any non-licensed software on any
    computer provided by Athens-Limestone Hospital.
  • Not exhibit or divulge the contents of any record
    or report except to fulfill work assignment and
    in accordance with Athens-Limestone Hospital
    policy.
  • Not remove any record or report from the office
    where it is kept except in the performance of my
    duties.
  • Report any violation of the policy and procedure.
  • Not release system/application/network passwords
    in order to access Athens-Limestone Hospital
    information systems.

25
COMPUTER AND INFORMATION USAGE AGREEMENT FOR
HOSPITAL STAFF
  • Ensure that all computer equipment (i.e.
    monitors, printers) is positioned in a manner so
    as confidential information is not viewable by
    unauthorized individuals.
  • Respect the confidentiality of any reports
    printed from any information system containing
    patient/member information and handle, store, and
    dispose of the reports appropriately.
  • Not divulge any information identifying a patient
    or employee.
  • Understand that all access to the system will be
    monitored.
  • Understand that my obligations to this agreement
    will continue after termination of my employment
    or relationship with Athens-Limestone Hospital.
    I understand that my privileges hereunder are
    subject to periodic review, revision, and if
    appropriate, renewal.

26
COMPUTER AND INFORMATION USAGE AGREEMENT FOR
HOSPITAL STAFF
  • Those who cannot accept these standards of
    behavior may be denied access to relevant
    computer systems and networks. Violators may
    also be subject to penalties, including
    disciplinary action, under policies of
    Athens-Limestone Hospital and under laws of the
    State of Alabama or the United States of America
    to the extent applicable. By signing this, I
    agree that I have read, understand and will
    comply with the agreement.
  • Print Name___________________________________
    Signature_________________________________
  • Department___________________________________
    Date_________________________________
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