decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
DME Model Compliance Plan / Risk Areas / Risk areas
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Article Overview
This premium article reviews a durable medical equipment supplier compliance framework and the major risk areas identified in an OIG model compliance plan. It is aimed at DME suppliers, compliance staff, billing personnel, and managers who need a broad understanding of policy development, monitoring, documentation, payer-related concerns, marketing and referral issues, and overpayment handling. The article also references related Medicare, OIG, and fraud-and-abuse guidance that shapes supplier compliance planning.
Why This Topic Matters
DME suppliers operate in a highly regulated environment where billing, documentation, referral, enrollment, and marketing practices can create program integrity exposure. Understanding the main compliance risk areas helps organizations structure internal controls, training, and oversight to reduce audit, repayment, and enforcement risk.
Article Sections
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Policy and training expectations
Introduces the need for written policies, procedures, and staff training tailored to supplier functions. Summarizes the role of compliance oversight and related government guidance.
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DME compliance risk areas
Presents the major categories of supplier risk addressed in the OIG model compliance plan. The section spans billing, documentation, medical necessity, payer relations, referrals, enrollment, and other operational concerns.
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Additional considerations for suppliers
Addresses follow-up issues such as monitoring for recurring noncompliance and using internal manuals for smaller suppliers. Emphasizes keeping guidance accessible and aligned with identified risk areas.
What You Will Learn
- What kinds of topics a DME compliance plan should cover
- How the article groups supplier compliance risk areas
- Which operational functions commonly require written controls and training
- What broader categories of Medicare and OIG guidance influence supplier compliance programs
- How suppliers should think about ongoing review of risk areas and internal manuals
Who Should Read This
- Durable medical equipment suppliers
- Compliance officers
- Billing and coding staff
- Practice managers
- Healthcare attorneys
- Revenue cycle staff
Codes Discussed
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