Tips on Healthcare Compliance Programs
The far reaching implications of your practice not being aware of and in tune with an aggressive compliance program can be well documented by the number of practices that have fallen prey to simply ignoring the obvious.
Compliance programs are mandatory. They must include proactive education, clear definitions of what constitutes non-compliance and a way of assuring compliance is not simply the absence of fraud, waste and abuse, but audits that look for and resolves possible issues.
Compliance must be an ongoing program that makes employees aware of their responsibility and role in keeping the practice safe from potential compliance issues. To do that, practice personnel must be aware of what is expected and reminded frequently. All practice personnel, from the providers to the check in person, to the biller must all receive the same level of education and information to protect the practice and patients.
It is estimated the United States loses $275 billion annually on waste in healthcare through administrative inefficiencies, fraud and abuse – that’s nearly $9,000 per second.
Compliance is more than preventing and avoiding fraud waste and abuse. It is driving real value. The millions of dollars saved through identifying errors and a proactive plan to prevent errors are real dollars. Uncovering and identifying wasteful spending is an integral part of any best in class compliance program and equates to millions of dollars saved on prescription drugs.
Even a single provider practice needs a compliance program. Creating and sustaining a good compliance program can be done in a variety of ways. If resources and dollars are your concern, there are available means of meeting your compliance needs without huge expense.
The OIG has several free programs that you can participate in:
- Provider compliance training via podcast, webcast and written material
- Compliance healthcare material to post on healthcare information boards
- A road map for new physicians – how to start and maintain compliance in your office
Internally, a practice should:
- Hire a compliance officer (consider collaborating with several practices to spread cost and reap reward)
- Develop written policies and standards (many free guides)
- Implement a comprehensive employee training program (again to spread cost and attain better value, do this with other practices)
- Report overpayments, reportable events, and ongoing investigations/legal proceedings
Having a compliance program must be given thought and attention. Talk to larger practices and other practices to hear what they are doing to not only provide compliance programs but also bring real value to their practices. Hire a consultantthat is qualified to advise you on the right and optimal program designed for your practice.
Most importantly, do not be overwhelmed by the scope of what is required and do nothing. It will cost you so much more in the long run.