decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Special Advisory Bulletins / OIG-CMS Special Advisory Bulletin 99-3_Nov 10, 1999 / Compliance Practices
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Article Overview
This OIG and CMS bulletin explains compliance concerns for hospitals when staff discuss authorization, insurance, or payment issues with patients seeking emergency care. It is intended for hospital compliance teams, emergency department staff, managed care administrators, and coding/billing professionals who need to understand the policy context and risk areas discussed in the advisory. The article focuses on general compliance practices and the circumstances that can affect a hospital’s obligations during emergency screening and stabilization.
Why This Topic Matters
Hospitals and revenue cycle teams can use this bulletin to understand compliance risks tied to emergency department interactions, patient communication, and managed care authorization issues. It matters because the article highlights how operational practices may intersect with federal hospital obligations and enforcement concerns.
What You Will Learn
- The compliance concerns raised when emergency care discussions involve insurance or prior authorization
- How hospital staff communications can affect emergency department processes
- The general policy areas addressed by OIG and CMS guidance for hospitals
- The types of compliance practices discussed for reducing risk in emergency care settings
Who Should Read This
- Hospital compliance officers
- Emergency department leadership
- Hospital billing and revenue cycle staff
- Managed care administrators
- Coding and reimbursement professionals
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