AHLA Representing Hospitals and Health Systems Handbook (AHLA Members)
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The tremendous growth of hospitals and health systems in the United States was spurred on after World War Two with passage of the Hill-Burton Act, which funded the construction of new facilities, and the Social Security Act of 1965, which established Medicare and Medicaid and greatly expanded the number of people who have some form of health insurance. The universe of hospitals and health systems began to grow and evolve, and continues to do so. This Handbook examines the multitude of issues that those who represent hospitals and health system need to be informed about but will also be a critical guide for those who represent physicians, diagnostic imaging facilities, other health care facilities, as well as financial institutions.
• Establishment of facilities;
• State licensing requirements;
• Certification process;
• Payment methodologies;
• State and Federal fraud and abuse regulations; and
• Operational issues, including patient relations, privacy, grievance rights, and consent to treatment
All health attorneys and others in the health care field who need to understand the intricacies and complexities of hospitals and health systems will find Representing Hospitals and Health Systems Handbook, First Edition an indispensable resource.
Published August, 2016.
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Table of contents
PART 1 Background and History
Chapter 1 Background and History
PART 2 Establishing and Maintaining Hospitals
Chapter 2 Licensure, Certification and Related Requirements
Chapter 3 Medicare Enrollment and Certifications
PART 3 Sources of Revenue-Payment for Hospital Services
Chapter 4 Sources of Revenue
Chapter 5 Medicare Payment Adjustments
Chapter 6 Rural Hospitals and Other Providers
Chapter 7 Other Medicare Payment Issues
Chapter 8 Medicare Provider-Based Status
Chapter 9 Medicare Audits and Appeals Process
Chapter 10 Medicare and Medicaid Alternative Payment Models
Chapter 11 Medicaid
Chapter 12 Private Payers
Chapter 13 The Uninsured and Underinsured
PART 4 Fraud and Abuse Principles for Hospitals
Chapter 14 Federal Fraud and Abuse Laws
Chapter 15 State Fraud and Abuse Laws
Chapter 16 Fraud and Abuse Issues Unique to Hospitals
Chapter 17 Compliance with Fraud and Abuse Laws
PART 5 Relationships with Physicians
Chapter 18 Common Arrangements with Physicians
Appendix 18A Duties of Medical Director, Surgical Intensive Care Unit
Chapter 19 Hospital-Physician Alignment Strategies
Chapter 20 Medical Staff Issues
PART 6 Hospital Operational Issues
Chapter 21 Patient Relations
Chapter 22 EMTALA
Chapter 23 Risk Management
Chapter 24 Privacy and Medical Records
Chapter 25 Telehealth-The Newest Age of Health Care Delivery
Appendix 25.1 Telemedicine Credentialing Agreement
Chapter 26 Hospital Contracting Issues
Chapter 27 340B ISSUES
Chapter 28 Clinical Research
PART 7 Transactions
Chapter 29 TRANSACTIONS
PART 8 Integrated Health Systems
Chapter 30 Other Providers
PART 9 Miscellaneous
Chapter 31 Academic Medical Centers
Chapter 32 Public Hospitals
Chapter 33 Children's Hospitals
Chapter 34 Antitrust Issues For Hospitals And Health Systems
Chapter 35 Tax Issues
Appendix 35A Hospital Joint Venture Policy
Appendix 35B Hospital Calendar Year 2015 Conflict of Interest and Disclosure Statement for Board of Trustees, Officers and Key Employees
Appendix 35C Flowchart for Application of Rev. Proc. 97-13
Chapter 36 Governance
Chapter 37 Labor and Employment
Chapter 38 Real Estate Issues