Healthcare compliances training and discussion blog

Archive for August, 2009

Joint Commission! for Healthcare

What is JCAHO? here’s a short introduction of  JCAHO that i found at the  Joint commission website.

JCAHO stands for the Joint Commission on the Accreditation of Healthcare Organizations a private nongovernmental agency formed to set up guidelines for the operation of hospitals and other health care facilities, conduct surveys, and awards accreditation for the attainment of high standards of quality in institutional medical care in the United States. The Joint Commission is dedicated to improving quality of healthcare. The mission of Joint Commission is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.

The Joint Commission has been nation’s predominant standards-setting and accrediting body in health care since 1951. It evaluates and accredits more than 16,000 health care organizations and programs in the United States. The Joint Commission has maintained state-of-the-art standards that focus on improving the quality and safety of care provided by health care organizations. The Joint Commission’s comprehensive process evaluates an organization’s compliance with these standards and other accreditation or certification requirements. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. An organization must undergo an on-site survey by a Joint Commission survey team at least every three years to earn and maintain The Joint Commission’s Gold Seal of Approval.

Accreditation and certification services

The Joint Commission provides accreditation services for the following types of organizations:

  • General, psychiatric, children’s and rehabilitation hospitals
  • Critical access hospitals
  • Medical equipment services, hospice services and other home care organizations
  • Nursing homes and other long term care facilities
  • Behavioral health care organizations, addiction services
  • Rehabilitation centers, group practices, office-based surgeries and other ambulatory care providers
  • Independent or freestanding laboratories
  • The Joint Commission also awards Disease Specific Care Certification to health plans, disease management service companies, hospitals and other care delivery settings that provide disease management and chronic care services. The Joint Commission also has a Health Care Staffing Services Certification Program and is developing a certification program for transplant centers and health care services

Benefits of Joint Commission accreditation and certification

  • Strengthens community confidence in the quality and safety of care, treatment and services
  • Provides a competitive edge in the marketplace
  • Improves risk management and risk reduction
  • Provides education on good practices to improve business operations
  • Provides professional advice and counsel, enhancing staff education
  • Enhances staff recruitment and development
  • Recognized by select insurers and other third parties
  • May fulfill regulatory requirements in select states

Wow.. I dint know that JCAHO covered so many aspects.



New HIPAA Special Enrollment Rights

I hope you all might be aware about the special enrollment rights from HIPAA, here are some details about it.

Latest Special Enrollment Rights originated by Children’s Health Insurance Program Reauthorization Act of 2009 made effective from April 1, 2009 imposes new notice and disclosure obligations for employers. New HIPAA Special Enrollment Rights requires employers to provide a new notice to employees, and requires employers to disclose certain health plan information to states. The HIPAA Special Enrollment rights are not applicable to health FSAs as they are treated as excepted benefits.

New HIPAA Special Enrollment Events:

  • Loss of Coverage Due to Loss of Eligibility for Medicaid or CHIPs

An employer group health plan must permit eligible employees special enrollment if employees loses its Medicaid or CHIP coverage due to loss of eligibility.

  • Eligibility for Premium Assistance under Medicaid and CHIPs

An employer group health plan must permit eligible employees special enrollment if employees becomes eligible for Medicaid or CHIP premium assistance.

New HIPAA Special Enrollment Notice:

The final HIPAA regulations require that group health plans must notify to each employee and his or her dependents of any potentially and currently available premium assistance program in the state where the employee resides. The Department of Health & Human Services is directed by Congress to develop model notices by February 4, 2010 to comply with the notice requirement. These notices can be provided stand-alone or can be distributed along with health plan eligibility notices, open enrollment materials or summary plan descriptions.

Group health plan administrators are required to disclose information that a state needs to determine cost-effectiveness for its provision of premium assistance. Here also the DOL and HHS have been directed to develop a model coverage coordination disclosure form that will apply to information required by the states beginning with the first year on or after development of the model notice.

The notice must be issued not later than eligibility under the health plan. The employee must request for the new special enrollment events within 60 days of the loss of Medicaid or CHIP coverage or determination of eligibility for Medicaid or CHIP premium assistance. Failure to comply with the employee notice requirement or to disclose required health plan information to the state may penalize employers with $100 per day.

What now employers required to do?

Employers need to revise mid-year enrollment policies, amend all health and welfare plan documents and Section 125 cafeteria plan documents. Apart from this employers should review their current plan coordination of benefit rules and make necessary changes required to make to the group health plan to Medicaid or CHIP coverage.

Health Care E-learning

E-learning is one of the major internet tools that allow us to share and manage knowledge and expertise of the professionals to get the right information to the right people at their own pace. E-learning method helps to save on transport costs and on time and brings revolution in the learning environment. E-learning affects each and every industry and plays a major role in the success of the health care industry. The rapid changes in the healthcare industry necessitate continuous competency-based online education requirements.

In the health sector, current health care policies and procedures are rapidly put in place requires service modernization and improvement to support the transformation of health services. E-learning technology can support these changes and delivers high quality learning solutions. Health care sector needs to evaluate available e-learning platforms, learning management system and other approaches to deliver assured content through new emerging technologies to transform the health care curriculum and its assessment.

OSHA. I think i have heard the name somewhere !

Good Morning Health care Readers. Today, i wanna discuss about OSHA. I have been thinking HIPAA as sole compliance for health care industry, but i guess i was wrong.. let me give you a glance over OSHA.

The Occupational Safety and Health Administration, an agency of the US government under the Department of Labor enacted by Congress on December 29, 1970 to prevent work-related injuries, illnesses and deaths by enforcing rules for workplace safety and health. It ensures safety at work and a healthful work environment.

In 1999, there were 5.7 million occupational injuries and illnesses among U.S. workers. Nearly 6.3 of every 100 workers faced job-related injury and 6023 workers lost their lives on the job. But subsequent to OSHA being created in 1971, occupational deaths in US have declined by half and injuries by 40%.

The agency has framed workplace standards and policies businesses to adhere to these standards. It also encourages educational program for small business owners and corporations and plans to form partnerships to improve workplace safety and health.

According to OSHA, “the agency’s mission is to assure the safety and health of America’s workers by setting and enforcing standards; providing training, outreach, and education; establishing partnerships; and encouraging continual improvement in workplace safety and health.

OSHA regulations applies to all private-sector employers in all states and U.S territories and does not include employers in the public sector, self-employed individuals, family members operating a firm or domestic household workers. OSHA regulations requires states to develop their own safety and health plans, but an individual state’s OSHA plans must be strictly regulated as the federal OSHA Act and must be sanctioned by federal OSHA.


Great oppurtunity for Healthcare Students…

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Help us teach the healthcare folks how to get the best training on healthcare compliances. I would appreciate comments and views from all our readers.


An Introduction to HIPAA

Today, i would like to tell you something about HIPAA, tough alot of my Health care professionals folks would be aware about it but its a introduction to all our new Health care beginners…

HIPAA: Health Information Privacy and Security

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and its regulations was enacted by congress on August 21, 1996 to protect the privacy and security of patient’s personal health information.  The regulation obligates healthcare providers to establish national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers. The purpose of this security rule is to improve the portability of continuity of health insurance in the group and individual markets, combat fraud, waste and abuse in health insurance and health care delivery.  Privacy and security procedures in the administrative simplification section designed to streamline the administration of health insurance by recognizing the efficiencies and cost savings technology. Healthcare entity if fails to comply with these regulations may have to pay million of dollars. Anyone dealing with sensitive data must follow most strict security policy available.

HIPAA consists of:

  • – Healthcare access, portability and renewability
  • – Preventing health-care fraud and abuse
  • – Tax related health plan provisions
  • – Application and enforcement of group health planned requirements
  • – Revenue offsets

Who is covered by HIPAA? The Privacy rule applies only to covered entities.

Covered entities include:

  • Health care clearing houses- a public or private entity that facilitates the processing of nonstandard, health information data elements into standard data elements.
  • Health care providers- a provider of medical or other health services and any other person furnishing healthcare services or supplies.
  • Health plans- an individual or group plan that provides or pays the cost of medical care, with the exception of liability and worker’s compensation plans.

HIPAA has achieved great success – there have been many positive strides with regards to securing and protecting sensitive healthcare information. HIPAA has made considerable contributions resulted into increase in the utilization of electronic medical record systems, to implement secure, industry-wide messaging standards. The future of HIPAA for Healthcare will provide single set of information for all payers, standard coding practices, no human interference required for remittance, posting and billing. Privacy policy may add obstacles for physicians and other employees to access medical information but provide patients with trust willing to share information.

I hope this introduction would be helpful to all Health care newbies .


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