Links

Links to other compliance resources

 

Internal Resources

UNC: Conflicts of Interest Program

Describes policies of the University of North Carolina at Chapel Hill relating to conflicts of interest (individual, institutional, and external).

 

Government and Professional Resources

American Medical Association

Homepage for the American Medical Association, which provides information on healthcare policy and legislation, continuing medical education resources, and academic publications.

Association of American Medical Colleges

Homepage for the Association of American Medical Colleges, which provides news, advocacy resources, and data analysis for academic medical centers.

CMS - Medicare

Homepage for the Centers for Medicare and Medicaid Services (CMS).

CMS - Medicare Coverage Database

Link to the National Coverage Determinations policies and Local Coverage Determination policies for specific diagnoses and procedures covered by Medicare.

CMS - Medicare Learning Network

Medicare educational resources, including MLN Matters articles, Medicare Quarterly Compliance newsletters, weekly Provider eNews, and web-based training courses.

CMS - Newsroom

A good source for CMS fact sheets and press releases. Note the search box in the upper right.

CMS - Regulations and Guidance

Provides links to the Medicare Manuals, HIPAA Administrative Simplification, legislation, regulations and policies, review board and administrative decisions, and special topics. Some information is arranged by provider type.

Decision Appeals Board - HHS

Helpful in developing an understanding of how regulations are interpreted and applied to actual decisions related to some of the key areas identified in the OIG Work Plan, for example what constitutes or represents provider based status.

e-CFR

Homepage for searching the electronic version of the Code of Federal Regulations (eCFR). Healthcare regulations are in Title 42.

Federal Register - HHS

List of Federal Register entries by the U.S. Department of Health and Human Services (including the Centers for Medicare and Medicaid Services (CMS)).

MPFS - 2016 Final Rule

The 2016 Medicare Physician Fee Schedule final rule.

NC Board of Nursing

Homepage for the NC Board of Nursing.

NC General Statutes

Table of Contents for the NC General Statutes. Regulations applicable to healthcare facilities are in Chapter 131E. Regulations applicable to Medicine and Allied Occupations appear in Chapter 90.

NC Department of Medical Assistance - Fraud, Waste, and Abuse

Gives examples of and reporting options for Medicaid fraud, waste, and abuse, as well as information on: excluded providers, Medicaid Integrity audits, and the Payment Error Rate Management (PERM) program.

NC Department of Medical Assistance - Provider Portal

Provider information concerning the Medicaid program, including: provider fee schedules, clinical coverage policies, Medicaid forms, provider enrollment, and ICD-10.

NC Medicaid Bulletins:

November 2015 - Present

2000 - October 2015

Medicaid general and special bulletins on coverage criteria, billing information, and program requirements.

NC Medicaid RAC

Link to current North Carolina Medicaid RAC audits.

NC Medical Board

Homepage for the NC Medical Board.

NC TRACKS

Homepage for NCTracks, North Carolina’s multi-payer Medicaid management information system.

OIG - Annual Work Plan - 2016

The Annual Work Plan summarizes new and ongoing reviews and activities that the Office of the Inspector General (OIG) will pursue with respect to healthcare programs and operations during the fiscal year.

OIG - Compliance Education

Provides free healthcare fraud and abuse training for providers, compliance professionals, healthcare attorneys, and healthcare boards.

OIG - Compliance Guidance

Contains OIG advisory opinions, provider education, corporate integrity agreements, open letters on OIG policies, RAT-STATS, safe harbor regulations, self-disclosure information, and special fraud alerts / bulletins / guidance pertaining to federal healthcare programs.

OIG - Exclusions Program

Provides information about the OIG’s authority to exclude individuals and entities from participating in federal healthcare programs, guidance related to the Exclusion Program, and a searchable database (LEIE) of excluded individuals and entities.

OIG - Medicare Compliance Reviews

OIG reports assessing whether audited organizations met Medicare requirements for billing, coding, and program participation. Audits often focus on items in the OIG Annual Work Plan.

OPPS - 2016 Final Rule

The 2016 Outpatient Prospective Payment System final rule. Note that the “inpatient only list” is in Appendix E.

Palmetto GBA - Medicare Monthly Advisories (Part B)

Monthly compilation of changes to changes to the Medicare Part B program.

Palmetto GBA - What’s New (Part B)

Helpful in keeping up to date on the policies and practices of North Carolina’s Medicare Administrative Contractor (MAC) – Palmetto GBA

Palmetto GBA - Quarterly Updates

Sign-up for webinars on quarterly Medicare updates. Part B covers outpatient care.

SAM - Excluded Parties List

The System for Awards Management (SAM) database compiles debarment actions taken by various federal agencies, including exclusion actions taken by the OIG.

TRICARE - handbook and manuals

Link to TRICARE policies and guidelines for billing and documentation.