Did you do the right thing, the right way today? It may not always be clear for employees to determine the “right” thing to do. Therefore, developing a strong foundation for your practice should begin with compliance, ensuring excellence in all areas.
Although, it is not mandatory for all practices, with the propagation of healthcare legislation, itis imperative for practice’s to implement compliance programs to reduce and/or eliminate fraud and abuse. Compliance is an on-going process that requires daily attention for ease of success. Successful compliance programs should be straightforwardly adopted into your current work-flow; with tough development and implementationyou can even improve daily processes. Even if your practice currently has a compliance program, you should perform an evaluation of its effectiveness and ensure it comprises all ofbelow outlined elements:
- Development and implementation of a compliance plan, including written policies and procedures for practice standards and compliance;
- Designation of compliance officer and compliance committee;
- Performance of appropriate compliance training and education;
- Establishment of effective lines of communication;
- Publication and enforcement of disciplinary standards;
- Performance of monitoring and auditing and
- Investigation, response and development of corrective actions to prevent future similar issues.
An effective compliance plan should be developed, reviewed, accepted and approved by your practice’s management staff and owners, prior to implementation. A thorough compliance plan should include and explain compliance policies, standards and procedures with a detail of consequences for non-compliance, with an added interest to federal and state regulations and guidelines in the following areas:
- Billing and Coding Compliance;
- False Claims Act;
- Qui Tam;
- Healthcare Fraud and Abuse Laws;
- Stark Law;
- Anti-Kickback Statute;
- Equal Employment and Labor Standard Laws;
- Worker Safety and Environmental Protection;
- Antitrust Laws;
- Patient Records and Confidentiality Laws; and
- Corporate Management and Responsibility.
Your compliance program is designed to be followed; therefore, having an effective compliance officer is key. A compliance officer’s job should be clearly defined to include any areas that the individual is responsible for. As part of your compliance program, make sure the individual is qualified. The Patient Protection and Affordable Care Act of 2010 (“PPACA”) stresses the importance of your compliance officer and the necessity not to appoint an invidual with a tendency to engage in criminal, civil, or administrative violations.Your compliance officer or designated employee must understand the plan thorough and demand enforcement thereof.
Providing training and education is important, not only to your practice’s employees, but also to all practicinghealthcare professionals. On-going training can be provided in diverse methods; in-person, newsletters, web-based, seminars, etc. Education of current and upcoming changes in healthcare can be a little overwhelming, so staying actively abreast can provide your practice an added since of security of compliance.
Development and maintenance of a healthcare compliance program is vital to the success of a practice. But, a compliance plan will not include every possible situation, nor will it specifically encompass all applicable rules and regulations. So, assist your employees by keeping a line of communication open at all times to report any concerns and questions regarding compliance. Also openly accept any ideas for process improvements, encouraging a team approach to compliance, allowing employees to assist in development and implementation. This tactic will help employees better understand the practice’s management behaviors and decisions. A team approach can assist employees striveto go above and beyond,achieving excellence in compliance.
The compliance plan should be consistently followed, so adoption is critical for enforcement. Employees should be neither, expected, nor allowed to act illegally or unethically, even if instructed by a superior or when it seems to bein the best interest of the practice. Employees should have an understanding of the practice’s compliance program and standards that apply to their position. So creating awareness off the required written and implied practice’s compliance infrastructure is pertinent for enforcement.
Periodically evaluate your practice by conducting audits, scheduled and randomto eliminate risks. The lack of an effective compliance program also could be a risk in itself.
“Insanity has sometimes been defined as ‘Doing the same thing, in the same way, expecting a different outcome’”.Compliance issues will not correct themselves. A three step process should be followed when a compliance issue presents. These steps include:a thorough investigation, with a timely response, with a corrective action plan. Not completing the process would be insane. By doing so, your practice can eliminate any future financial loss.
As with any task, compliance can be easily forgotten, so creating a compliance program is not enough. Your practice must also create a sense of constant awareness. Educating employees of your practice’s compliance structure and consequences of non-compliance can build creative destructions of bad habits and produce results of 100% compliance 100% of the time.
Compliance is everyone’s responsibility. Did you do the right thing the right way today? If you can answer, “YES”, without any doubt, then you are probably acting compliantly. However, if you have any doubt about your decisions or behaviors, then you should stop, think and ask. In asking, be sure to consult the appropriate designated individual within your practice; also, utilizing any available resources for assistance.
To eliminate risk, maintain compliance consistently by setting expectations to provide high quality healthcare, while making the right performance decisions in the right way, each and every day.