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AHLA Representing Hospitals and Health Systems Handbook (AHLA Members)

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ISBN: 9781632813473
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ISBN: 9781632813763
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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 new 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.

Coverage Includes:

      •   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.

Authors / Contributors

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