Practice Compliance

Healthcare Preventative Compliance and Defense Order Form


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TITLE  Brief  Description Price
  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
  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
       (Surprise Bill Forms)
Comply with NY Surprise Bill Law by adopting proper disclosure forms, compliance policy and notifications. $850
Looking for representation or require assistance? Contact Jennifer
Kirschenbaum, Esq. at (516) 747-6700 x. 302 or at

  Notice of Privacy
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
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. $150.00
  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
Make sure your relationships with third parties are structured properly and that you have a proper business associate agreement in place. $375.00
        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
Looking for representation or require assistance that is not a standardized form? Contact Jennifer Kirschenbaum, Esq. at (516) 747-6700 x. 302 or at
  Standard Form Billing
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
Training Sessions
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
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
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.
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:
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
(As it appears on credit card):
  First:      Middle Initial:      Last:
SECURITY CODE (CVV)    (3 digit code from back of VISA/MC/DISC card)
(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 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.

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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