Medicare Compliance for Healthcare Personnel

(based on 504 customer ratings)

Author: Christopher Young
Reviewer: Barbara Cebulski, MS, MLS(ASCP)

This course covers all elements of a successful Medicare compliance program. LMRPs, ABNs, coding, and requisitions are given full treatment. Special sections for billing departments, managers, and sales / marketing departments emphasize requirements specific for these areas. Ten case studies allow employees to practice their knowledge and get feedback. This course is ideal for front line healthcare workers, sales, and clerical staff.


  • Define "voluntary compliance program" and discuss the elements that should be included.
  • Identify the Medicare laws and regulations.
  • Identify compliance problems and issues.
  • Explain each of these terms or processes that are related to Medicare reimbursements: Medical necessity; International Classification of Diseases (ICD) coding; Current Procedural Terminology (CPT) coding; Advance Beneficiary Notice.
  • State the responsibilities of administration, management, employees, and the billing department that are related to Medicare compliance.

Course Outline

  • Voluntary Compliance Program
    • Introduction
      • What is a Voluntary Compliance Program?
    • Seven Elements of a Compliance Program
      • Seven Fundamental Elements of a Voluntary Compliance Program
      • Element 1
      • Element 2
      • Element 3
      • Element 4
      • Element 5
      • Element 6
      • Element 7
      • Your healthcare facility has a compliance officer (CO) and a Compliance Committee. Which of the following statements is true regarding the individuals...
  • Laws and Regulations
      • Laws and Regulations Applicable to Medicare
      • The law that prohibits healthcare providers and payers from improperly or inappropriately using a patient's confidential health information, requires ...
  • Compliance Issues
    • Confidentiality
      • Confidentiality
      • Case Study
    • Billing
      • Billing
      • Fraud and Abuse
      • Fraud and Abuse, continued
      • Billing for Patient Tests and Services
    • Inducements
      • Kickbacks (Inducements)
    • Documentation
      • Documentation
    • Whistleblowers
      • Whistleblowers
  • Processes and issues related to Medicare Reimbursement
    • Medical Necessity
      • Medical Necessity
    • ABNs
      • Advance Beneficiary Notice (ABN)
      • ABN, continued
      • ABN Form CMS-R-131
    • Coding
      • International Classification of Disease (ICD) Coding
      • International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System (ICD-10-CM/PCS) Coding
      • HCPCS and CPT Coding
  • Responsibilities for Medicare Compliance
      • Administration's Responsibilities
      • Management Personnel Responsibilities
      • Billing Department
      • Case Study
      • Employees' Responsibilities
  • References
      • References

Additional Information

Intended Audience: All healthcare personnel.
Level of Instruction: Basic
Author information: Christopher Young, of Laboratory Management Support Services, Phoenix, AZ, is an independent consultant, and nationally recognized speaker and expert currently specializing in compliance, sales and marketing, and customer service, as they pertain to clinical laboratories. He has extensive first-hand laboratory experience, in positions ranging from phlebotomist, to decision support coordinator, and in his consulting practice.
Reviewer information: Barbara Cebulski, MS, MLS(ASCP) has over 40 years of experience in the medical laboratory profession as a technologist, section supervisor, and laboratory manager. She was an Inspection and Technical Specialist for nine years with the College of American Pathologists in the Laboratory Accreditation Program and, until her retirement in 2015, was Program Director for MediaLab, Inc. Barbara holds a Masters in Instructional Technology from Georgia State University.

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This course is part of:
25--High Risk Billing
23--Employee's Responsibility
33--Special Role for Managers