AHBA Survey Check List
1. Company Ownership has been verified.
2. Other Business affiliations, partnership or company associations if any have been verified.
3. Sixty percent (60%) of company’s current business has been verified.
4. Companies that receive less than sixty percent (60%) healthcare business have created a special healthcare division or subsidiary for verification of compliance.
5. Owners-Officers or Managers have confirmed 5 years service or business association with healthcare providers.
Verified: ________ .
6. Company has confirmed retention of qualified legal counsel:
·Name: ____ .
·Verified: ____ .
7. Company has provided certificate of E & O insurance coverange:
·Company Name: ____
·Verified current policy effective date:____
8. Company has provided evidence of timely remittance:
.
9. Company has a Compliance Officer who will supervise a Compliance Committee:
·Compliance Officer Name:____
10. Company has provided a HIPPA-HITECH compliance statement including knowledge of Red Flag requirements and possible penalties for violations.
11. Company has provided an organizational chart showing Division Manager and special division if applicable.
12. Company has provided certification for all healthcare specialist/personnel.
13. Company has provided proof of continuing education / training and documented methods of testing.
14. Company has provided samples of Business Associate Agreement and Chain of Trust Agreements.
15. Company has provided documentation of PHI security standards and technology system.
16. Company has confirmed and committed that all healthcare business assigned or purchased will be serviced exclusively within U.S. Territories. The only exception will be that permission to use off shore vendor is granted by the provider and the Business Associate Agreement contains a Chain of Trust clause that included all Associate Vendors.
17. Company has provided for review all brochures and marketing material for the healthcare industry.
18. Company has a compliance policy and business license (including individual state requirements) for all states where they service healthcare clients.
AHBA Accreditation Programs
Declaration
· I confirm that all accreditation requirements have been reviewed and we are in agreement on all program conditions.
· I have appointed a Compliance Officer responsible for oversight and enforcement of all compliance requirements.
· I confirm by my signature below that all requirements stated on AHBA Survey/Requirements List have been reviewed and I agree to support compliance by all healthcare Business Associate personnel.
· I understand and agree that any violation of the accreditation terms must be corrected within 60 days of discovery. I understand that failure to complete these corrections will result in the following penalties:
o The awarded Accreditation certificate will be revoked
o The Company Name will be removed from the accreditation roster.
o The revocation notice will be imparted to all partipating healthcare associations (e.g. AHA, CHA, AMA etc…).
All accredited Healthcare Business Associates shall agree to the following declaration:
“All AHB Accredited Business Associates agree to abide by all policies and procedure required by Healthcare Providers. Our mission is to provide quality service that achieves the best results possible while protecting the public image of our providers and business partners, and the dignity of the patients they serve.”
Authorized Signature:
Title:
Company Name:
All requirements on the survey list have been reviewed and compliance has been confirmed:
Signature/Date:________ /________
Approved AHBA Surveyor
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