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Practice Compliance

Healthcare Preventative Compliance and Defense Order Form

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Compliance Document Brief Description Price
  COMPLIANCE PLAN Complete policies for your Practice that: (i) certify the Practice's commitment to Compliance; (ii) designates a Compliance Officer in charge of training, education and enforcement; (iii) identifies and lists potential red flags; (iv) dictates appropriate coding and billing procedures; and (v) provides policies to handle employee issues, audits and investigations.  Complies with requirements by third party payors, Office of Inspector General, Federal payors and malpractice carriers. $2,225.00
 HIPAA POLICIES Includes privacy policies, email policy, patient complaint form, patient consent for use and disclosure, privacy officer job responsibilities, privacy rule staff instructions, release of PHI to Third Parties, Request for an accounting, request for limitations and restrictions of PHI, training documentation form, work force agreement and log to track disclosures. (Complies with new HITECH Act.) $500.00
  RED FLAGS RULE POLICY Complies with Federal Trade Commission requirements. $50.00
  EMPLOYEE HANDBOOK Includes provisions governing employee conduct. (Index available upon request.) $750.00
  NYS MISCONDUCT PLEDGE Complies with NYS Department of Education law s. 6530, defining professional misconduct. $300.00
  ALL IN ONE COMPLIANCE PLAN, HIPAA POLICIES, RED FLAGS RULE POLICY, EMPLOYEE HANDBOOK, NYS MISCONDUCT PLEDGE, PLUS TERMINATION OF PATIENT RELATIONSHIP FORM, NOTIFICATION OF NON-COVERAGE POLICY, etc. $3,000.00
  PREMIUM PACKAGING
If you select Premium Packaging we will organize your Compliance Program in professional packaging and mail to your attention. $30.00
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.

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 alarm company information as you want it to read on your compliance program.
Practice Name:  
Stree Address  
City:        State:       Zip Code:
Telephone:  
Complince Officer Name  
PAYMENT METHOD: (Please remember to hit submit if using a credit card)
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. 208
 

  Check box if you are a MSSNY, Queens or Bronx County Medical Society Member, or New York Chiropractic Council Member. We reserve the right to confirm membership status as current prior to providing your Compliance Program documents are reduced 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 and hard copy mailed.  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.


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