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Biomedical subjects

P R DeMuro

Publications and source records attributed to P R DeMuro.

12 recordsLinked to original sources
PubMed2001

HIPAA privacy standards raise complex implementation issues.

In November 1999, under the mandate of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, HHS issued proposed standards to protect the privacy of electronically transmitted personal health information. With publication of the final standards due soon, healthcare organizations must prepare to implement new processes and information systems to comply with the HIPAA requirements. The privacy standards are intended to accomplish three broad objectives: define the circumstances in which protected health information may be used and disclosed, establish certain individual rights regarding protected health information, and require that administrative safeguards be adopted to ensure the privacy of protected health information. Among the required administrative safeguards are designation of a privacy officer, implementation of compliance training programs for all applicable staff, establishment of a complaint system, and implementation of appropriate sanctions for violations of privacy requirements.

Computer Security↗
PubMed1995

Paying specialists and subspecialists on a capitated basis.

Primary care physicians are the focal point of any capitated system. They are the gatekeepers to specialty and subspecialty physicians and to ancillary providers. However, many experts now believe that to truly align the incentives of all providers and to bring costs to the lowest level possible, specialty and subspecialty physicians also should be paid on a capitated basis.

Capitation Fee↗
PubMed1994

Provider alliances: key to healthcare reform.

No matter what form healthcare reform takes, managed care is the future of health care, and the future is now. Hospitals and physicians will have to work together as partners and align incentives. It will be necessary to develop more primary care capability to adequately compete in the managed care arena. There will need to be increased coordination of managed care contracting between hospitals and physicians.

Comprehensive Health Care↗
PubMed1994

Management services organizations.

This chapter defines a management services organization (MSO), and discusses the goals and objectives of hospitals and physicians in creating an MSO and the advantages and disadvantages of an MSO. It stresses the necessity of developing a business plan in the formation of an MSO and discusses organizational forms and MSO activities, such as managed care contracting, billing, information systems, utilization management and review, the provision of supplies, medical office space, equipment, staff, and turnkey arrangements. In addition, it discusses the structuring of MSO fees and a number of organizational structures for MSOs and legal issues affecting them.

Contract Services↗
PubMed1994

Special Medicare reimbursement and fraud and abuse considerations for management services organizations, medical foundations, and integrated delivery systems.

This chapter discusses certain Medicare reimbursement and fraud and abuse considerations for management services organizations (MSOs), medical foundations, and integrated delivery systems. It stresses the necessity of a business plan, the sources of capitalization that might be used in creating an integrated delivery system, and their effect on Medicare reimbursement. It also discusses related party principles and considerations and the Medicare "incident to" regulations. Furthermore, it discusses the application of certain Medicare safe harbor regulations on MSOs' structures and services, and those of medical foundations and integrated delivery systems.

Capital Financing↗
PubMed1993

Fraud and abuse compliance programs: their time has come.

Two recent developments in Federal law enforcement should prompt healthcare providers to establish or augment programs to detect and prevent Medicare and Medicaid fraud and abuse. New and controversial Federal sentencing guidelines require judges to impose multi-million dollar fines on companies convicted of certain Federal crimes, and substantial civil monetary penalties may be imposed for violation of the Medicare and Medicaid fraud and abuse laws. One of the ways to avoid these penalties is to establish an effective compliance program designed to prevent criminal conduct before it happens.

Fraud↗
PubMed1991

Crisis management can leave residual effects.

A healthcare organization that once suffered from poor financial performance may fail to correct recovery methods that can cause lingering legal and accounting problems. A crisis management style is prone to creating problems with an organization's debt structure, Medicare and Medicaid payment, tax issues, labor relations, licensing and accreditation, compliance with fraud and abuse rules, and accounting for charity care. After stabilizing a worrisome financial situation, a healthcare organization should conduct an internal audit to ensure that its legal and accounting practices remain above board.

Bankruptcy↗
PubMed1989

Joint ventures for mobile equipment reduce hospital costs.

Many hospitals cannot afford to purchase all of the high-technology equipment necessary to provide a full range of services. Healthcare organizations should consider entering a joint venture to gain access to mobile equipment. However, changes pending in Washington (see Up-data, p. 5) dictate caution for all healthcare joint ventures, particularly those involving physician investments.

Cost Control↗