Anesthesia Compliance Consultants

Providing compliance education and services
to anesthesia providers, hospitals and billing companies


Compliance and HIPAA Training

We specialize in providing Anesthesia Compliance and HIPAA training to anesthesia professionals using our web-based education platform. Choose from the courses listed below or allow us to create a program tailored specifically to your organization, type of practice or company.

We offer the following courses in an online setting:

  • Anesthesia Compliance
  • Anesthesia HIPAA Privacy
  • Anesthesia Compliance and Privacy
  • Anesthesia Evaluation and Management Coding
  • Fraud, Waste and Abuse Training

We provide online group training. We will educate your company on anesthesia compliance and HIPAA Privacy. Contact us for more information and group rates.


Compliance Plans

ACC will assist with the creation of a compliance plan for your organization. Our team of experienced professionals crafts compliance plans consistent with regulatory, medical, billing and coding standards.

“We understand anesthesia: we have stood in your shoes.”


Latest News

HIPAA Gap Analysis or a HIPAA Risk Analysis?

Posted on Oct 9, 2019 in HIPAA

HIPAA Gap Analysis

What is the difference between a HIPAA Gap Analysis and a HIPAA Risk Analysis?  Many organizations use these interchangeably, however, they are not correct in doing so.  Don’t make the same mistake.

Office of Civil Rights Requirements

The Office for Civil Rights clearly spelled out the steps and requirements for a HIPAA Security Risk Analysis.  As a result, it requires covered entities to conduct an accurate and thorough assessment. It must consider potential risks and vulnerabilities to the confidentiality, integrity and availability of electronic protected health information held by the organization.  Furthermore, entities must consider the potential risks, threats and vulnerabilities to all of the covered entities ePHI.  This includes all ePHI which is created received, maintained or transmitted, including the source or location of the ePHI

Understanding a HIPAA Gap Analysis

The HIPAA Rule does not require a HIPAA Gap Analysis.  The Gap Analysis is usually a limited evaluation of a covered entity or business associate’s organization to reveal whether there are certain policies, controls or safeguards required by the HIPAA.  As a result, it is important rules are in place and implemented. The HIPAA Gap analysis should begin with a review of all policies, procedures, processes, practices and systems. It must investigate all facilities that relate to privacy, uses and disclosures of PHI.

Gap Analysis Insufficient for HIPAA Rule

A Gap Analysis  does not satisfy the Security Risk Analysis requirement. It does not demonstrate an accurate and thorough analysis. In effect, it must consider all risks, threats  and vulnerabilities to all of the ePHI an entity creates, receives, maintains or transmits.  Consequently, the gap analysis is not equivalent to the risk analysis as it does not satisfy the rule as specified  by 45 C.F.R. §164.308(a)(ii)(A).  It is important to note that OCR expects a covered entity to document and implement all of the necessary regulations of the HIPAA Rule to obtain a Compliant rating.

Therefore, it is important to identify your covered entity’s needs and determine whether you require a Gap Analysis or Risk Analysis.  Most important, assure that the vendor you engage is qualified to perform the specific type of analysis that you need. 

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The Exclusion Statute

Posted on Jul 25, 2019 in Medicare Compliance, Medicare Fraud

The Exclusion Statute

Your Anesthesia Compliance Tip for today is on the

Exclusion Statute:

Through the Exclusion Statute, the Office of Inspector General has the authority to exclude individuals and entities from Federally funded healthcare programs. In addition, it also maintains a list of all presently excluded entities and individuals. This list is commonly known as the List of Excluded Individuals/Entities (LEIE). Most importantly, all organizations who hire an individual or entity that your foresee will participate in a government program must review this list.

Initially we must focus on Mandatory exclusions:

First of these are the exclusions by which the OIG is required by law to exclude from participation in all Federal health care programs individuals convicted of the following types of criminal offenses:

  1. Initially, Medicare or Medicaid fraud, or any offenses related to the delivery of services under Medicare, Medicaid, or State programs
  2. Secondly, patient abuse or neglect
  3. Next, felony convictions for health care-related fraud, theft, or other financial misconduct
  4. Finally, felony convictions relating to unlawful manufacture, distribution prescription, or dispensing of controlled substances

 Secondly there are Permissive exclusions:

These are exclusions in which the OIG has discretion to exclude individuals and entities on a number of grounds,

  1. First, are misdemeanor convictions related to health care fraud other than Medicare or a State health program
  2. Fraud in a program funded by any Federal, State or local government agency
  3. Misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances
  4. Suspension, revocation, or surrender of a license to provide health care for reasons bearing on professional competence, professional performance, or financial integrity
  5. Provision of unnecessary or substandard services
  6. Submission of false or fraudulent claims to a Federal health care program
  7. Engaging in unlawful kickback arrangements
  8. Finally, defaulting on health education loan or scholarship obligations; and controlling a sanctioned entity as an owner, officer, or managing employee

Most important, to avoid Civil Monetary Penalty liability, health care entities need to routinely check the (LEIE) List of Excluded Individuals and Entities to ensure that new hires and current employees are not on the excluded list. Above all it is perilous to ignore the Exclusion Statute. For any questions feel free to contact us.

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The Anti-Kickback Statute

Posted on Jun 24, 2019 in Billing, Medicare Compliance, Medicare Fraud

The Anti-Kickback Statute

A Criminal Law

The Anti-Kickback Statute is a criminal law that prohibits the knowing and willful payment or “remuneration” to induce or reward patient referrals.  It also applies to  the generation of business involving any item or service payable by the Federal health care programs. Remuneration includes anything of value and can take many forms besides cash, such as free rent, expensive hotel stays and meals, and excessive compensation for medical directorships or consultancies. Learn more.

Penalties

Criminal penalties and administrative sanctions for violating the Anti-Kickback Statute include fines, jail terms, and exclusion from participation in the Federal health care programs. Under this law, physicians who pay or accept kickbacksalso face penalties of up to $50,000 per kickback plus three times the amount of the remuneration.

Target for Kickbacks

As a physician, you are an attractive target for kickback schemes because you can be a source of referrals for fellow physicians or other health care providers and suppliers. You decide what drugs your patients use, which specialists they see, and what health care services and supplies they receive. Many companies will attempt to take advantage of this relationship. They will attempt to pay you for the referrals.

Moreover, just as it is illegal for you to take money from providers and suppliers in return for the referral of your Medicare and Medicaid patients, it is illegal for you to pay others to refer their Medicare and Medicaid patients to you.

In addition, Medicare and Medicaid programs require patients to pay copays for services and you are required to collect them. Waiving these copays could implicate the Anti-Kickback Statute. Of course it is OK to waive if the patient cannot afford or if you have made efforts to collect.

Contact us for more information on these important topics and anesthesia compliance training for you and your company.

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Technical Safeguards Protect PHI

Posted on Jun 19, 2019 in HIPAA

Technical Safeguards
Technical Safeguards Protect PHI

Why Technical Safeguards?

Technical safeguards protect PHI and have become a major part of any HIPAA Privacy program. They are key elements that help to maintain the safety of ePHI as the internet changes.  Consequently technical safeguards are important due to technology advancements in the health care industry. The challenge of healthcare organizations is that of protecting electronic protected health information (EPHI).   Most importantly, this includes items such as electronic health records, from various internal and external risks.

Comply with Technical Safeguards

The Security Rule, requires for a covered entity to comply with the Technical Safeguard standards and certain implementation specifications.  A covered entity may use any security measures that allow it to reasonably and appropriately do so.

Define “Technical Safeguards”

The Security Rule defines technical safeguards as “the technology and the policy and procedures for its use that protect electronic protected health information and control access to it.”  Consequently, this rule is based on several fundamental concepts.  These are flexibility, scalability and technology neutrality. Therefore, no specific requirements for types of technology to implement are identified.

Implementing “The Security Rule”

The Rule allows the use of security measures.  Consequently, these allows it to reasonably and appropriately  implement the standards and implementation specifications.  Because of this the covered entity must determine which security measures and specific technologies are reasonable and appropriate for implementation in its organization.  There are a variety of  measures which can assist an organization to meet these standards.  A more detailed description can be found at the HIPAA Security Series published by HHS.gov.

The Importance of “The Security Rule”

Technical safeguards are important due to technology advancements.  The take away is that Technical Safeguards protect PHI.  Most importantly covered entities and business associates who deal with electronic PHI must review their use of Technical Safeguards to be fully in compliance.  

Feel free to contact us for more guidance on this important topic.

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False Claims Act and Anesthesia

Posted on Jun 5, 2019 in Billing, Compliance, Medicare Compliance

False Claims Act and Anesthesia

An Important Law

The Federal False Claims Act and anesthesia is a topic worth considering. Of note, there are many federal laws in place that govern Medicare fraud and abuse. One of the most important laws that addresses fraud is the Federal False Claims Act.    Most importantly, it allows private citizens to bring civil actions on behalf of the United States.

The False Claims Act protects the Federal Government from overcharging or selling substandard goods or services. Consequently it imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government. Of interest, this is a law that dates back to the Civil War era.

Knowledge of Wrongdoing

The terms “knowing” and “knowingly” mean a person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information related to the claim. Furthermore, to violate the False Claims Act does not require proof of specific intent to defraud.

Qui Tam Complaint

The qui tam provision allows a person to file a qui tam action. Initially the government seals the qui tam complaint 60 days. Secondly, during this time the government will investigate the allegations and decide if it is proceeding with the action. Eventually if convinced by the case the government will prosecute. Finally, the individual who initially brought the case may receive between 15 and 25 percent of the amount recovered by the government.

Lack of Compliance Plan

Of importance is that the lack of a compliance plan increases the threat of Qui tam lawsuits.  Indeed this act provides significant financial incentives for private citizens to come forward as whistleblowers.

In short, the Federal False Claims Act and anesthesia is a topic that cannot be taken lightly.  Anesthesia providers should be prepared with an active compliance plan.

Contact us for more information on these important topics and anesthesia compliance training for you and your company.  ACC Contact Us

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