ED Coding & Reimbursement Alert - 2012 Issue 25
Compliance: Create Your Compliance Plan in Advance of ACA Requirement
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Article Overview
This article discusses the growing importance of compliance programs for healthcare practices under the Affordable Care Act and related Medicaid expectations. It outlines the general elements a practice should consider, notes the role of federal guidance and specialty resources, and emphasizes the need for a plan tailored to the practice rather than a generic template. The content is aimed at providers, billers, compliance staff, and practice managers who want to assess whether their current compliance efforts are aligned with emerging requirements.
Why This Topic Matters
Compliance programs can affect both Medicare and Medicaid participation, so practices may need to prepare before formal requirements are finalized. Understanding the broad structure of a compliant program helps practices reduce risk, improve internal oversight, and avoid relying on one-size-fits-all documents.
Article Sections
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Background
Introduces the ACA-related context for compliance planning and explains why future requirements may affect different types of practices. It also summarizes the role of federal and state healthcare programs in shaping expectations.
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Start With the OIG's Seven Components
Describes the general framework referenced by federal guidance for building a compliance program. The section also notes that guidance may vary by practice setting and organizational type.
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Resources
Reviews outside resources that may support compliance planning, including legal counsel, consulting firms, and specialty societies. It focuses on support options for developing a practice-specific plan.
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Avoid Cookie-Cutter Compliance
Emphasizes the importance of customizing a compliance plan to a practice's own operations and risks. The section warns against using generic materials without tailoring them to the practice.
What You Will Learn
- How ACA-related policy developments may affect compliance planning for healthcare practices
- What broad components are commonly associated with a practice compliance program
- What kinds of outside resources may assist with compliance plan development
- Why a tailored compliance plan is preferred over a generic template
Who Should Read This
- Physicians
- Practice managers
- Medical billers
- Compliance officers
- Healthcare administrators
- Coding and billing professionals
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