Compliance Program - What are the Requirements to Implement an Effective Program?

by  Christine Taxin
August 1st, 2017

All sponsors are required to adopt and implement an effective compliance program, which must include measures to prevent, detect, and correct Part C or D program non-compliance as well as FWA.

The compliance program must, at a minimum, include the following core requirements:

 1. Written Policies, Procedures, and Standards of Conduct;

 2. Compliance Officer, Compliance Committee, and High-Level Oversight;

 3. Effective Training and Education;

 4. Effective Lines of Communication;

 5. Well-Publicized Disciplinary Standards;

 6. Effective System for Routine Monitoring and Identification of Compliance Risks; and

 7. Procedures and System for Prompt Response to Compliance Issues.

In order to be effective, a sponsor’s compliance program must be fully implemented and should be tailored to each sponsor’s unique organization, operations, and circumstances. A compliance program will not be effective unless sponsors devote adequate resources to the program. Adequate resources include those that are sufficient to do the following:

 1. Promote and enforce its Standards of Conduct;

 2. Promote and enforce its compliance program;

 3. Effectively train and educate its governing body members, employees, and FDRs;

 4. Effectively establish lines of communication within itself and between itself and its FDRs;

 5. Oversee FDR compliance with Medicare Part C and D requirements;

 6. Establish and implement an effective system for routine auditing and monitoring; and

 7. Identify and promptly respond to risks and findings.

CMS will consider a sponsor’s size, structure, business model, activities, the extent of its delegation of responsibilities to other entities, the breadth of its operation, and the risks it faces in evaluating whether adequate resources have been devoted to the compliance program.

Compliance Program - What are the Requirements to Implement an Effective Program?. (2017, August 1). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/compliance-program-what-are-the-requirements-to-implement-an-effective-program-31564.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.