This determination is made by identifying who, by virtue of their normal role at Livewell, is the most likely person that would identify risk for breaking this law. This person will be recommended for the Compliance Committee by completing a Committee Member Recommendation Sheet (CMRS).Download this list of Compliance Committee Member Options with brief descriptions to assist your decision-making process.
Download the Committee Member Recommendation Sheet (CMRS) template. This template contains further guidance and complete instructions describing how to complete a CMRS. You will complete one of these for each of the 6 required CMRS in this project. Download a Sample Completed (CMRS) to help guide your efforts. Compliance Committee Member Options with Brief Description
•
HIM Director: oversees the management, retention and completion of patient
documentation plus manages coding
•
Med Staff Office/Credentialing Specialist: coordinates hiring contracts and
hiring requirements for physicians
•
Risk Management Officer: responsible for early detection and prevention of
risk and accidents at the facility
•
Human Resources Director: manages the hiring of staff, discipline of staff and
coordinates workplace safety
•
Patient Accounts Director: oversees the accuracy and timely filing of patient
bills to insurance and patient
•
Nursing Administration Director: directs the clinical care provided to patients
and the processes used to deliver care which includes oversight of all nursing
managers
•
Quality Improvement Manager: leads activities that provide more efficient
and streamlined workflow in hospital environment which includes both clinical
areas and non-clinical areas
•
HIPAA Privacy Officer: oversees all ongoing activities related to the
development, implementation and maintenance of the organization privacy
policies in accordance with federal and state laws
•
Patient Advocate Manager: Alerts legal department of potential issues and
presents patient complaints to administration. Proposes resolutions for patient
complaints, advocates for the patient, and strives to improve the hospital’s
reputation.
Health Information Compliance – Course Project – Committee Member Recommendation Sheet (CMRS)
Instructions: Use the CMRS form below to identify and recommend appropriate Compliance Committee Members. Replace the detailed
guidelines in the boxes below with your content.
The Regulation
– the Research
Law of Origin, Regulation,
etc. →
Emergency Medical Treatment and Labor Act (EMTALA)
Citation for above law →
Emergency Medical Treatment & Labor Act (EMTALA). (2012, March 26). Retrieved March 8, 2016, from
https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html
Explain the purpose →
The law requires a facility to complete a healthcare assessment of any patient presenting themselves
for emergent medical care or when a female patient arrives in active labor whether or not they are able
to pay or have medical insurance. The hospital must then stabilize the patient or prepare to safely
transfer them to an accepting facility.
Patients – from being denied life-saving or necessary health treatment when they have no provision to
pay.
Who and/or what does it
protect? →
Your
Understanding
Livewell’s
Roll-outCompliance
Plan and
Committee
Who is at risk for violating
it? →
Emergency and immediate care facilities.
Who will coordinate the policy and monitor it? →
-HIM Director
-Medical Staff Office/Credentialing Director
-Risk Management Officer
-Human Resources Director
-Patient Accounts Director
-Nursing Administration Director
-Quality Improvement Manager
-HIPAA Privacy Officer
-Patient Advocate Manager
Why should this be a part
of the compliance
committee/plan?
Narrative in student’s own
words – minimum of 4
sentences. →
Nursing Administration Director- The ED Director will have first-hand
exposure to incoming patients. The ED Director is a nurse and will be
responsible for onboarding and training all ED nurses. The nursing staff
attends to the patients and have a reporting responsibility.
The facility wants to abide by EMTALA to avoid being sued by the federal government. The facility does
not want to have their license to practice medicine removed by the State they exist in. The facility does
not want to have a bad reputation with patients in the area. All of these things will damage future
referrals and numbers of patients seeking care at the facility. Then the employees will not have jobs
here.
Health Information Compliance – Course Project – Committee Member Recommendation Sheet (CMRS)
Instructions: Use the CMRS form below to identify and recommend appropriate Compliance Committee Members. Replace the detailed
guidelines in the boxes below with your content.
The Regulation
– the Research
Your
Understanding
Livewell’s
Roll-outCompliance
Plan and
Committee
Law of Origin, Regulation,
etc. →
Citation for above law →
Using your readings, activities and assignments as guidance, identify a specific Law/Regulation/Standard that each healthcare facility
needs to be aware of and comply with during regular business in the USA. Locate its origin and copy it from there. For APA format, the
needed citation must be recorded below in the box below.
Using Noodle tools, create a proper citation for the Law/Regulation/Standard above. Place the citation here in this box.
Explain the purpose →
Using your own words and properly composed sentences, state the purpose of the above Law/Regulation/Standard – help us
understand what this does for healthcare.
Who and/or what does it
protect? →
Continuing from above – now that you have explained WHAT the law does, tell us who or what it protects – who benefits from the
protection of the Law/Regulation/Standard?
Who is at risk for violating
it? →
Now that we know what the Law/Regulation/Standard does and who it protects, indicate here who commonly violates it – is it
patients, for example, or doctors, or healthcare facilities, etc.
Who will coordinate the policy and monitor it? →
-HIM Director
-Medical Staff Office/Credentialing Director
-Risk Management Officer
-Human Resources Director
-Patient Accounts Director
-Nursing Administration Director
-Quality Improvement Manager
-HIPAA Privacy Officer
-Patient Advocate Manager
Why should this be a part
of the compliance
committee/plan?
Narrative in student’s own
words – minimum of 4
sentences. →
Now that you have the Law/Regulation/Standard identified, cited and fully explained – who (which
job title) at the Livewell facility should monitor for it? Who, by virtue of their NORMAL ROLE AT
LIVEWELL, is the most likely person that would identify risk for breaking this law? The title you list
here IS THE TITLE that you have chosen as a member of the Compliance Committee at Livewell.
Please explain your connection between the Law/Regulation/Standard above and the Compliance Committee. Help us understand your
reasoning, your choices above – why will LIVEWELL be more likely to avoid being charged with Healthcare Fraud and
Abuse if they follow your recommendations for this Compliance Committee Member and monitoring of this
Law/Regulation/Standard?
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