BC Advantage - 2011 Issue 4
Compliance Plans
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Article Overview
This article explains why billing services should maintain a compliance plan and describes the general elements commonly included in such plans. It discusses third-party billing service responsibilities, references guidance from the Office of the Inspector General, and covers broad compliance topics such as documentation, claims handling, communication, education, monitoring, and response to problems. The article is aimed at billing service owners, staff, and providers who want a general understanding of compliance-plan expectations and risk areas.
Why This Topic Matters
Compliance planning is a core part of reducing billing risk, supporting internal oversight, and helping providers and billing services align on policies and procedures. The topic is especially relevant for organizations that handle claims, coding, or protected health information.
What You Will Learn
- Why billing services use compliance plans
- The role of written policies and procedures
- How compliance oversight and training are organized
- Why monitoring, auditing, and corrective action are part of compliance planning
- General risk areas associated with third-party billing services
Who Should Read This
- Medical billing services
- Billing service owners and managers
- Provider practices
- Compliance staff
- Medical coding and billing professionals
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