decisionhealth Newsletters, Part B News - 2007 Issue 10 (October)
Take a fresh look at your compliance plan
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Article Overview
This article discusses how billing organizations and practices can revisit compliance planning in light of fraud scrutiny and regulatory expectations. It focuses on general compliance-program elements, monitoring and audit practices, staff education, complaint handling, and the use of outside benchmarks to evaluate whether physician earnings appear within expected ranges. The piece is aimed at billers, compliance staff, and practice managers who want to compare their internal processes against widely cited compliance guidance.
Why This Topic Matters
Strong compliance planning helps billing organizations document good-faith oversight, monitor for irregular activity, and respond appropriately when concerns arise. The article is relevant for readers who need a broad checkup of their compliance framework and a reminder of the kinds of oversight practices that attract regulatory attention.
What You Will Learn
- Why compliance planning remains important for third-party billers
- The general elements commonly included in effective compliance programs
- How billing organizations may think about audits, monitoring, and complaint handling
- How external benchmarks can be used to assess whether earnings appear atypical
Who Should Read This
- Third-party billers
- Compliance officers
- Medical practice managers
- Coding and reimbursement professionals
- Healthcare consultants
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