Conflicts of Interest Disclosure Form

1 - Duties of Compliance Personnel

2 - Charitable Contributions

3 - Reporting Potential Issues or Areas of Non-Compliance

4 - Compliance Committee

5 - Excluded or Debarred Persons or Entities

6 - Non-Retaliation

7 - Overview of Relevant Laws

8 - Preventing Fraud, Waste, and Abuse

9 - Exit Interviews

10 - Responding to Government Investigations

11 - Document Retention

12 - Monitoring and Auditing

13 - Compliance Investigations

14 - Overpayments and Refunds

15 - Risk Assessments

16 - Education and Training

17 - Policy and Procedure Development

18 - Business Courtesies to Potential Referral Sources

108 - Compliance and Integrity Committee

114 - Focus Arrangements Review and Approval Process

115 - Reportable Events

116 - Management Certifications

201 - Relationships with Billing Entities

303 - Professional Courtesies and Patient Discounts

304 - Correspondence with Medicare and Medicaid Carriers

305 - Suspension of The Medical Record

307 - EMTALA: Anti-Dumping and Anti-Exclusion

308 - Critical Care

309 - Physician Services at Teaching Hospitals

310 - Billing for Services Provided by an APP

311 - Medical Necessity

313 - Use of Scribes

314 - General Coding and Billing for Hospital Based Services

HIPAA Policies & Procedures

Notice of Privacy Practices*

*Note – Facility based Providers will use and abide by the Facility’s Notice of Privacy Practices.

For questions regarding HIPAA related matters, please contact the Privacy Officer, Jillian Marcus, at complianceconcerns@envisionhealth.com or 615.922.6125 .