ED Coding & Reimbursement Alert - 2013 Issue 17
Compliance: Bust These 5 Common Compliance Myths
Subscribe or sign in to view the full article.
Article Overview
This article reviews five common myths about healthcare compliance and risk management. It discusses reliance on legal advice, overpayment retention and false claims exposure, audit detection for low-volume providers, the reach of audit contractors beyond hospitals, and the expectation to make good-faith efforts to comply with statutory requirements even before implementing regulations are finalized. It is relevant to providers, compliance teams, and practice managers who want a high-level understanding of compliance risk areas and enforcement awareness.
Why This Topic Matters
Misunderstandings about compliance can create avoidable legal and operational risk. This article helps healthcare organizations recognize where informal assumptions may be unsafe and why proactive compliance efforts matter.
Article Sections
-
Compliance myth 1
Discusses reliance on outside advice and the importance of acting in good faith when evaluating compliance questions. Covers the general distinction between informal reassurance and formal legal guidance.
-
Compliance myth 2
Explores false claims exposure related to retained overpayments and the level of awareness that can affect liability. Includes a broad discussion of negligence, recklessness, and compliance procedures.
-
Compliance myth 3
Addresses audit and enforcement risk for smaller providers and the use of data analysis by government programs. Reviews how billing patterns and statistical outliers can draw attention.
-
Compliance myth 4
Covers audit focus areas discussed by recovery audit contractors and related oversight trends. Notes that enforcement activity may extend beyond the provider types most often discussed.
-
Compliance myth 5
Explains the expectation to begin complying with statutory requirements before all implementing regulations are issued. Discusses broad compliance responsibilities and early efforts to protect privacy-related information.
What You Will Learn
- Why relying on informal reassurance may not protect a provider in a compliance dispute
- How retained overpayments can create legal risk
- Why low-volume providers are still subject to audit detection
- How audit programs can affect provider groups beyond hospitals
- Why good-faith compliance efforts may be expected before regulations are finalized
Who Should Read This
- Healthcare providers
- Compliance officers
- Practice managers
- Billing managers
- Risk management professionals
- Healthcare consultants
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com