Building Tools - Terms You Need To Know
You’d never start a building project without some basic tools – hammers, nails, wood. The definition of some key terms and abbreviations are the basic tools you’ll need to follow this compliance guidance and to build and maintain your compliance program. Here they are:
Agent means someone who can make decisions for [PROVIDER], such as a director, officer, or administrator. Sometimes a physician, or an employee, or an independent contractor can act as an agent.
Board of Directors is the top governing body for a provider, unless the owner actually runs the provider. (It may have a different name, such as Board of Trustees.) It can assign the tasks set forth in this manual to officers, employees or independent contractors.
Centers for Medicare and Medicaid Services (CMS) is the federal agency that administers the Medicare and Medicaid programs. It is part of the U.S. Department of Health and Human Services or US DHHS.
Chief Executive Officer (CEO) is the top officer in [PROVIDER], such as a president. The CEO is responsible to the Board of Directors or owner, unless the CEO is the owner. The CEO can assign the tasks set forth in this manual to other people.
Compliance Officer runs [PROVIDER’s] day-to-day compliance program. The compliance officer can delegate tasks set forth in this manual, including investigations and inquiries, to others, but the final responsibility rests with compliance officer. The compliance officer must report periodically to the Board of Directors, CEO, and/or other management regarding [PROVIDER’s] compliance program. When there are special problems, the compliance officer needs to make special interim reports to the Board, CEO and management.
Corporate Compliance means [PROVIDER’s] efforts to obey the legal requirements for patient welfare, employee rights, proper coding and billing, and proper business arrangements with other providers and vendors, such as vendor agreements and physician agreements.
Corporate Compliance Manual and Code of Conduct (compliance manual) means the written compliance manual, with all its relevant attachments, exhibits, supplements, or amendments.
Corporate Compliance Program (CCP) means all the aspects of corporate compliance undertaken by [PROVIDER] including, but not limited to, the compliance manual, compliance training seminars, and the toll-free compliance hotline, the anonymous drop box, a post office box, and the inquiries, investigations and enforcement of the program.
Employees means any and all people employed by [PROVIDER], including officers and supervisors, as well as full-time and part-time paid staff [PROVIDER]. It does not mean independent contractors.
Facility Administrator is the top administrator at each of [PROVIDER’s] health facilities. The Administrator can assign tasks set forth in this compliance manual to other employees.
Health Facility means the [skilled nursing facility or nursing facility] located at [_________].
Independent Contractor is someone or some company that does work for [PROVIDER] under a contract. Physicians, linen suppliers, management companies and billing companies might be independent contractors.
Inspector General is an attorney and the head of the U.S. Department of Health and Human Services’ Office of Inspector General.
Nursing Facility (NF) is a long-term care facility that meets the federal requirements to provide nursing care. Not all NF’s provide nursing care that is intense enough to be considered skilled nursing care.
Office of Inspector General (OIG) means the U.S. Department of Health and Human Services’ Office of Inspector General. The OIG enforces many of the federal fraud and abuse laws applicable to health care providers.
Owner is the person or company that owns [PROVIDER]. Sometimes there is more than one owner. Note: The term “owner” may be used in place of the term “Board of Directors” throughout this manual when a provider either has no Board of Directors or opts to place ultimate responsibility for the corporate compliance program in the hands of the owners.
Physician Agreement is any written or oral agreement between [PROVIDER] and a physician or physician group. Physician agreements may relate to acquisitions, employment, consulting, building and/or equipment leases, joint ventures, loans, medical directors, partnerships, physician services, professional services, recruitment, risk sharing, security, service agreements, income guarantees, promissory notes, and many other things.
Physician is any physician, or physician group. Physicians include acupuncturists, chiropractors, optometrists, osteopaths, medical doctors, podiatrists, and psychologists, and any other heath services provider that the federal government defines as a physician.
Provider means the corporation, partnership, or other entity organized under the laws of the state of [_________], with its principal corporate offices presently located at [___________].
Provider’s Corporate Office is the corporate office and personnel of [PROVIDER], presently located at [___________].
Resident means a resident of [PROVIDER’s] health care facility.
Skilled Nursing Facility (SNF) is a long-term care facility that meets the federal requirements to provide skilled nursing care and is reimbursed for that care by Medicare and Medicaid.
Vendor means any seller, supplier, or provider of supplies or services to [PROVIDER]. Vendors may provide consultant services, physical, occupational, speech, and respiratory therapists, supplies, transportation, billing services, and many other services and things. A provider may contract with many vendors.
Vendor Agreement means any agreement with a vendor buy goods or services from the vendor. Vendors may provide consulting, lease buildings and/or equipment, enter into joint ventures, make loans, form partnerships, provide professional services, share business risks, or provide business services such as billing, with respect to [PROVIDER].