The Healthcare Compliance Professional's Guide to Policies and Procedures

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The Healthcare Compliance Professional's Guide to Policies and Procedures

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The Healthcare Compliance Professional's Guide to Policies and Procedures

Richard P.Kusserow

Ready-made compliance policies and procedures that you can adapt to your facility.

Policies and procedures are the backbone of any compliance program. Compliance professionals must ensure that their policies and procedures are effective and up to date. To ensure effectiveness, the OIG expects hospitals to regularly re-evaluate their policies and procedures.

Insight from a former Inspector General

The Healthcare Compliance Professional’s Guide to Policies and Procedures is written by former Inspector General Richard P. Kusserow.  He has filled this book with sample policies and procedures that hospitals can use to strengthen their existing compliance program or help build a new one.

Customize your program immediately

The Healthcare Compliance Professional’s Guide to Policies and Procedures provides the easy-to-use policies and procedures you need to ensure that your compliance program runs efficiently and smoothly. With these tools you will be able to:

  • Implement proven, effective policies and procedures by using the sample templates provided
  • Instruct staff with easy-to-comprehend instructions regarding policy and procedure development
  • Identify best practices for policy and procedure development that are most likely to pass OIG investigation
  • Ensure your policies are up to date with all legislation passed through the beginning of 2008


All of these sample policies and procedures can be used right away. Download our sample policies directly from the companion CD-ROM. You can then customize each document to fit your specific situation. It’s that easy to develop a proven, effective set of policies and procedures!

Take a look at the table of contents to see the variety of sample policies and procedures you will receive with The Healthcare Compliance Professional’s Guide to Policies and Procedures:

  • Compliance program oversight policies and procedures
    • Compliance officer duties and responsibilities
    • Confidentiality agreements
    • Compliance officer and legal counsel protocol
    • Records management
    • Standards of conduct
    • Ethics
  • Compliance education and training
  • Billing and coding policies
    • Accurate coding
    • Observation status
    • Accurate documentation
    • Prohibition of fraudulent and abusive billing
    • Medicare’s “incident to” rule
    • Charity/uninsured care
  • Medical necessity
    • How to check for medical necessity
    • ABN use for items and services that do not meet medical necessity
  • Conflicts of interest agreements
    • Gifts
    • Vendor relationships
    • Discounts/professional courtesies
  • Reporting compliance problems
    • Hotline use
    • Hotline auditing
    • Responses to complaints
    • Nonretaliation policy (whistleblower protection)
  • Auditing and monitoring
    • Procedures for documenting auditing and monitoring
    • Standards for auditing and monitoring
  • Policies specific to laws and regulations
    • Stark
    • Anti-kickback statute
    • False Claims Act
    • Deficit Reduction Act
    • EMTALA
    • HIPAA
  • Other risk areas
    • Quality of care
    • Clinical trials


About the Author:

Richard P. Kusserow is the founder and CEO of Strategic Management Systems, Inc.  In that capacity, he leads in evaluation of difficult compliance issues and began developing, evaluating, and enhancing compliance program effective in 1992.  He previously served for 11 years as the Inspector General (IG) of the Department of Health and Human Services (HHS) where he was responsible for all investigations, audits and inspections performed on behalf of the department.

Published: March 2008