Medicaid, Office of Medicaid Inspector General, Compliance, Compliance Program, Keeping your practice safe and compliant

Healthcare Preventative Compliance and Defense Order Form

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TITLE

Brief Description

Price

HIPAA COMPLIANCE

Notice of Privacy Practices	Required Notice of Privacy Practices covering allowable uses and disclosures of protected health information for patients, compliant with HIPAA as updated by the Final Omnibus Rule. Required by September 2013.	$350.00
Security Policy	Required Security Policy for staff use covering technical and administrative safeguards to electronic protected health information. Required NOW.	$375.00
Red Flags Policy	Protect your Practice from the threat of identity theft by adopting this Red Flag Policy for staff training and use.	$230.00

Breach Notification
Protocol

Adopt proper breach notification protocol so that your practice knows how to respond to a potential breach of protected health information in compliance with recently updated requirements.

$375.00

Consent for Disclosure

Ensure your patients are providing proper consent for uses and disclosures with this consent for disclosure form. Make sure you are communicating properly via email and on the phone with your patients.

$275.00

Financial Policy

Protect your practice's earnings by adopting a firm payment policy for patient execution.

$75.00

Required Office for Civil
Rights patient use and
disclosure package

The Office for Civil Rights (the "HIPAA Police") requires practices have specific policies on file for Patient Use and Staff Training. Be sure to comply by purchasing our package of required policies. Required policies for Patient Use and Staff Training.

$400.00

Business Associate
Agreement

Make sure your relationships with third parties are structured properly and that you have a proper business associate agreement in place.

$375.00

HIPAA POLICIES
ALL IN ONE

Not sure you have the most up to date or correct patient privacy forms? Our HIPAA package includes required HIPAA forms, staff training guides and required office policies for protected health information compliance. The All in One includes over TWENTY useful documents including: a Security Policy for electronic PHI, a Red Flags Policy protecting against identity theft, a regulatory compliant Business Associate Agreement, a Privacy Policy and much more.

$2,200.00

COMPLIANCE DOCUMENTS

COMPLIANCE PLAN

By purchasing this compliance plan you are adopting recommended Office of Inspector General billing guidelines, as well as New York State Medicaid Compliance requirements (required for certain practices ordering or receiving >$500k NYS Medicaid $). Protect your practice's revenue by protecting your billing process.

$2,225.00

EMPLOYEE HANDBOOK

Practice protection starts and ends oftentimes with employee conduct. Make sure your staff knows what is and is not acceptable by adopting a comprehensive employee handbook. Our employee handbook provides a complete policy for your staff that establishes required and acceptable conduct.

$900.00

OPIOID PRESCRIBING POLICY

Ensure your practice is properly adhering to controlled substance distribution and prescription requirements by adopting a Prescription Monitoring Program. Each policy is modified to conform with State requirements.

$1500.00

OON DISCLOSURE
FORMS
(Surprise Bill Forms)

Comply with NY Surprise Bill Law by adopting proper disclosure forms, compliance policy and notifications.

$850

Other

Looking for representation or require assistance? Contact Jennifer
Kirschenbaum, Esq. at (516) 747-6700 x. 302 or at jennifer@kirschenbaumesq.com.

Other

Looking for representation or require assistance that is not a standardized form? Contact Jennifer Kirschenbaum, Esq. at (516) 747-6700 x. 302 or at jennifer@kirschenbaumesq.com

BILLING COMPANY DOCUMENTS

Standard Form Billing
Contract

Include service, defense and collection provisions.

$375.00

Standard Form Business
Associate Agreement

Complies with HIPAA Rules, effective September 2013

$275.00

Billing Compliance Plan

Compliance with Office of Inspector General billing guidelines. Protect your Company's revenue by protecting your billing process.

$2,225.00

HIPAA Policies

Adopt proper HIPAA, Security and Breach Notification policies and procedures for your Company.

$1,250.00

Employee Handbook

Protection starts and ends oftentimes with employee conduct. Our employee handbook provides a complete policy for your staff that establishes required and acceptable conduct.

$900.00

Other

Looking for representation or require assistance? Contact Jennifer Kirschenbaum, Esq. at (516) 747-6700 x. 302 or at jennifer@kirschenbaumesq.com.

Training Sessions

1 HOUR TELEPHONE
CONFERENCE

Learn how to use your new compliance program effectively with a 1 hour conference call training session.

$300.00

IN-OFFICE TRAINING

Schedule in-office training by an approved Kirschenbaum Consultant for yourself and your staff to learn how to effectively use your new compliance program. (Applicable to all NYS downstate residents and some upstate residents depending on location. Travel costs are not included in price.)

$1,500.00

KIRSCHENBAUM
TRAINING SEMINAR

Attend Kirschenbaum & Kirschenbaum, P.C., training seminar via teleconference or in-person. (Call Eileen at (516) 747-6700 to find out our next seminar date.)

$100.00

Customization

CUSTOMIZED
COMPLIANCE
PROGRAM

If you would like an attorney to contact you to discuss customizing your forms to include policies that address your practice's unique and specific day-to-day operations please select this box.

TBD after phone consultation.

SEXUAL HARASSMENT POLICIES AND TRAINING

NYS Compliant Sexual Harassment Policies/Complaint Form/Employee Agreement	Customized Policy, Complaint Form and Employee Agreement with contractual protections for employer and INDEMNIFICATION by Employee for Offenses.	$450.00
LIVE WEBINAR EMPLOYEE TRAINING (1 HOUR)	Description: You pick the day and time and we will provide a Live training session by webinar for your staff - we will consult with you beforehand by phone so we can best assess your company's main areas of concern, or potential weaknesses. Your employees will have an opportunity to ask questions live on webinar or to email us after with concerns or complaints.	$550.00

PLEASE FILL OUT ALL FIELDS AND PRESS SUBMIT TO PROCESS YOUR ORDER:
Contact Name:		First: * Middle Initial: * Last: *
License Designation:
E-mail Address: *
BE CAREFUL: Enter practice information as you want it to read on your compliance program.
Practice Name:
Street Address
City:		State: Zip Code:
Telephone:
Compliance Officer Name
PAYMENT METHOD: (Please remember to hit submit if using a credit card so that your order may be processed.)

CREDIT CARD: MasterCard Visa Discover

CARD HOLDER'S NAME (As it appears on credit card):		First: Middle Initial: Last:
CREDIT CARD NUMBER		EXPIRATION DATE: Month Year :
SECURITY CODE (CVV)		(3 digit code from back of VISA/MC/DISC card)
TOTAL ORDER AMOUNT (to be billed to credit card)
CHECK/MONEY ORDER (Your order will not be processed until your funds have cleared our bank):

Please make checks payable to "KIRSCHENBAUM & KIRSCHENBAUM" and forward check with copy of form to:
Jennifer Kirschenbaum, Esq., 200 Garden City Plaza, Garden City, NY 11530.
(516)747-6700, Ext. 302

Check box if you are interested in someone from our firm contacting you to discuss assistance with collections.

Check box if you are a member of MSSNY, Bronx, Queens, New York, Suffolk, Ulster, Orange or Rockland County Medical Society, the New York State Dental Association, the New York State Radiology Society, the New York State Ophthalmological Society or the New York Chiropractic Council. We reserve the right to confirm membership status as current prior to providing your Compliance Program documents at reduced or promotional rates.

Important, you must agree to the following by checking the boxes (4) below or your order cannot be filled:

Certification: Purchaser acknowledges that the Compliance Documents comply with statutes, rules and regulations as of the date hereof and that regulatory requirements are subject to change at any time. Purchaser is solely responsible for maintaining the Compliance Documents and updating the contents therein to comply with regulatory changes.

Jurisdictional Agreement: Purchaser acknowledges and agrees that any claim or dispute against Jennifer Kirschenbaum and Kirschenbaum & Kirschenbaum PC must be commenced and maintained exclusively in Nassau County, New York, and that Jennifer Kirschenbaum and Kirschenbaum & Kirschenbaum PC shall not be subject to any other jurisdiction.

Use of Compliance Program: Purchaser acknowledges that it is a medical practice and agrees that the Compliance Program is for Purchaser's sole business use and Purchaser will not sell or provide the Compliance Program or any portion thereof to other medical practices.

Custom Compliance Program and possible modification in your jurisdiction: All Compliance Documents will be customized with your practice name and other information, and will be emailed to you in PDF. The Compliance Documents you have purchased are customized to incorporate Federal requirements and may not include required provisions in your jurisdiction. We recommend that you contact our office for a consultation or consult with a local attorney to review the Compliance Documents and make the necessary modifications incorporating legal requirements in the jurisdictions you conduct your practice. We will review and comment upon all modifications suggested by your local attorney without charge.

Email Alerts: By joining our healthcare listserv you will be kept up to date on compliance changes, receive articles on legal and other industry topics. There is no charge for this service. Check box to opt in to receive our emails.

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