December 12, 2016

Compliance Announcements

15

May 18

May 15, 2018

Compliance Reminder: National Health Care Anti-Fraud Association Fraud Stat

By SOMOS Community Care / Communications, Compliance

The National Health Care Anti-Fraud Association estimates that three percent of all health care spending, or $60 billion, is lost...

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15

May 18

May 15, 2018

Compliance Reminder: Health Care Fraud, Waste, and Abuse

By SOMOS Community Care / Communications, Compliance

Health care fraud, waste, and abuse not only contributes to higher insurance premiums; every dollar spent on fraudulent or abusive...

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8

May 18

May 8, 2018

Compliance Reminder: Examples of Fraud, Waste and Abuse by a provider

By SOMOS Community Care / Communications, Compliance

Examples of Fraud, Waste and Abuse by a provider include: Billing for Medicaid services that were not provided Billing for...

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1

May 18

May 1, 2018

Compliance Reminder: Examples of Fraud, Waste and Abuse by a patient/recipient

By SOMOS Community Care / Communications, Compliance

Examples of Fraud, Waste and Abuse by a patient/recipient include: Lending or sharing a Medicaid Identification card Forging or altering...

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24

Apr 18

April 24, 2018

Compliance Reminder: Compliance and Ethics Hotline

By SOMOS Community Care / Communications, Compliance

The Compliance and Ethics hotline makes it easy for you to report your concerns. An external vendor will answer your...

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17

Apr 18

April 17, 2018

Compliance Reminder: Features of successful Value-Based Payment programs

By SOMOS Community Care / Communications, Compliance

Features of successful Value-Based Payment programs: Sizable incentives Measure alignment Provider engagement Performance targets Data and other quality improvement support

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10

Apr 18

April 10, 2018

Compliance Reminder: Behavioral Health Medical Record Documentation Requirements

By SOMOS Community Care / Communications, Compliance

Behavioral Health Medical Record Documentation Requirements: Meet the State’s Medicaid program rules Reflect medical necessity and justify the treatment and...

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3

Apr 18

April 3, 2018

Compliance Reminder: Medicaid Audits

By SOMOS Community Care / Communications, Compliance

Medicaid Audits verifies: Medicaid reimbursable services were rendered for the dates billed Appropriate rate or procedure codes were billed for...

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20

Mar 18

March 20, 2018

Compliance Reminder: Compliance Process For Corrective Action

By SOMOS Community Care / Communications, Compliance

Compliance Process For Corrective Action: Define the problem Define the root cause Define the actions necessary to correct or prevent...

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13

Mar 18

March 13, 2018

Compliance Reminder: Self-Audit

By SOMOS Community Care / Communications, Compliance

Self-Audit is defined as the audit, examination or review performed within a physician’s office or health care organization. It focuses...

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2

Mar 18

March 2, 2018

Compliance Reminder: Integrate Compliance and Quality

By SOMOS Community Care / Communications, Compliance

Integrate Compliance and Quality Keep it simple Document everything Assign accountability Check for understanding Define Key Performance Indicators Measure results...

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23

Feb 18

February 23, 2018

Compliance Reminder: Effective Problem-Solving is Key

By SOMOS Community Care / Communications, Compliance

Effective problem-solving is key. Conducting an inventory process and identifying gaps and conflicts is important.

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15

Feb 18

February 15, 2018

Compliance Reminder: Treat Compliance as an Ongoing, Dynamic Effort

By SOMOS Community Care / Communications, Compliance

Treat Compliance as an ongoing, dynamic effort. It is not just steps towards periodic guidelines, but a mindset of continually...

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9

Feb 18

February 9, 2018

Compliance Reminder: Plan for Continuous Improvement

By SOMOS Community Care / Communications, Compliance

Plan for continuous improvement Plan Do Check Act

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2

Feb 18

February 2, 2018

Compliance Reminder: The 3 Cs of Compliance

By SOMOS Community Care / Communications, Compliance

The three C’s of Compliance Communication Confirmation Correction

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26

Jan 18

January 26, 2018

Compliance Reminder: U.S. Healthcare System Moves to Value Based Model

By SOMOS Community Care / Communications, Compliance

The US health care system is moving from a fee-for-service model to a valued based model. Instead of rewarding volume,...

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19

Jan 18

January 19, 2018

Compliance Reminder: Web Address for Compliance Department

By SOMOS Community Care / Communications, Compliance

Web address for Compliance department is compliance@acppps.org

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5

Jan 18

January 5, 2018

Compliance Reminder: Documentation is Key to Compliance

By SOMOS Community Care / Communications, Compliance

Documentation is key to compliance: Proves programs are effective and completed as written Improves patient care Reduces improper payments Demonstrates...

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21

Dec 17

December 21, 2017

Compliance Reminder: Gift Receipt Policy

By SOMOS Community Care / Communications, Compliance, News

SOMOS Community Care employees may accept a gift of nominal or minor value if the employee believes that the gift...

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19

Dec 17

December 19, 2017

Compliance Reminder: The Compliance and Ethics Hotline

By SOMOS Community Care / Compliance

The Compliance and Ethics hotline makes it easy for you to report your potential Compliance concerns/potential violations. An external vendor...

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12

Dec 17

December 12, 2017

Compliance Reminder: Make sure you use effective passwords on all devices

By SOMOS Community Care / Compliance

Please be aware that network password protocols have been implemented that require passwords to contain a maximum number of alpha,...

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5

Dec 17

December 5, 2017

Compliance Reminder: Utilize discretion in public or at social gatherings as it pertains to ACP

By SOMOS Community Care / Compliance

Always use discretion when discussing ACP business and be discreet at social gatherings and when discussing information in public regarding...

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28

Nov 17

November 28, 2017

Compliance Reminder: Promptly escalate any disclosure

By SOMOS Community Care / Compliance

If you become aware of any potential breach of privacy, please inform the Privacy & Security Officer initially, and, if...

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21

Nov 17

November 21, 2017

Compliance Reminder: Be professional in internal communications

By SOMOS Community Care / Compliance

Internal communications can often be transmitted without much thought as to who else might view them.  Therefore, it is important...

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14

Nov 17

November 14, 2017

Compliance Reminder: Honest and Ethical Conduct

By SOMOS Community Care / Compliance

ACP Compliance promotes following established procedures and conducting business in a professional and ethical manner.

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7

Nov 17

November 7, 2017

Compliance Reminder: Mobile Devices and Removable Media

By SOMOS Community Care / Compliance

Mobile devices store more sensitive data than your PC, be sure to check with the ACP IT department about proper...

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31

Oct 17

October 31, 2017

Compliance Reminder: Properly dispose of, or store, PHI when not in use

By SOMOS Community Care / Compliance

When destroying PHI in paper record format, place in the ACP secure disposal bins. ACP utilizes a certified document retention...

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24

Oct 17

October 24, 2017

Compliance Reminder: Ensure proper safeguards are in place before communicating electronically

By SOMOS Community Care / Compliance

HIPAA recommends using a fax cover sheet whenever sending faxes containing any sensitive or protected health information.

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17

Oct 17

October 17, 2017

Compliance Reminder: Recognizing Fraud, Waste and Abuse

By SOMOS Community Care / Compliance

Fraud - When someone intentionally falsifies information or deceives Medicaid (or Medicare). Waste - When someone consumes, spends, or expends...

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10

Oct 17

October 10, 2017

Compliance Reminder: Change Your Passwords

By SOMOS Community Care / Compliance

HIPAA recommends not sharing your password with anyone, and not writing passwords down and leaving them in areas that are...

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