Compliance plans

Increased Medicare fraud investigator scrutiny has made it even more critical for physicians and diagnostic testing providers to demonstrate a commitment to maintaining a culture of compliance and ethics that is fully embraced thought the practice.

 However, the prospect of developing a full-blown fraud and abuse compliance plan may seem overwhelming for many physicians but a compliance plan is really the only "insurance" you can put in place to help minimize legal and financial exposure from improper billing.  Consider starting small.  An annual coding and documentation audit with the help of a health care consultant is one of the best things you can do from a compliance standpoint and it need not be expensive.  Most importantly, however, when it comes to compliance, doing something is far better than doing nothing. 

 The keys to developing an effective and affordable basic compliance program are to: (1) put someone in charge of the process, (2) identify risk areas specific to the practice in question, (3) develop policies and procedures designed to address those risk areas, and (4) train employees about compliance.

 Sade Medicare Consulting has extensive experience in helping physician’s develop, implement and continually improve a high quality compliance plan that is based on the Office of Inspector General (OIG) model compliance plan and includes the following topics:

• Conducting internal monitoring and auditing;
• Implementing compliance and practice standards;
• Designating a compliance officer or contact;
• Conducting appropriate training and education;
• Responding appropriately to detected offenses and developing corrective action;
• Developing open lines of communication; and
• Enforcing disciplinary standards through well-publicized guidelines.