ED Coding & Reimbursement Alert - 2011 Issue 6
Compliance FAQs: Are You Appropriately Protecting Your Practice From Potential Compliance Allegations?
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Article Overview
This FAQ-style article explains general compliance management issues for physician practices and other Part B providers. It is aimed at practice administrators, physicians, billers, and compliance staff who want to assess whether their compliance program is current, operational, and able to address reporting, oversight, audit, and ethics concerns.
Why This Topic Matters
Strong compliance programs can help practices organize internal oversight, address risk areas, and prepare for external review. The article highlights practical governance and process topics that matter to day-to-day compliance operations.
Article Sections
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Know What's Required of Compliance Officer
Discusses the role of a compliance officer in a medical office and how responsibilities may be assigned or supported within the practice.
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Compliance Plan Alone Won't Protect You
Explains why a purchased or outdated compliance plan may not be sufficient and discusses the need for practice-specific compliance program development.
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Know the Audit Timelines
Covers audit scope and the general circumstances under which records and claims may be reviewed during compliance investigations.
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Identify Conflicts of Interest
Addresses conflict-of-interest policies, disclosure processes, and related internal documentation for practices with business interests.
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Show Employees Where to Turn to Report Compliance Issues
Describes complaint reporting pathways, internal escalation options, and general protections for reporting compliance concerns.
What You Will Learn
- How compliance officer responsibilities are generally structured in a medical practice
- Why a compliance plan should be practice-specific and maintained over time
- How audit review scope may relate to a patient's coverage period and related claims
- What broad elements belong in a conflict-of-interest disclosure process
- How practices can set up internal reporting options for compliance concerns
Who Should Read This
- Physicians
- Practice administrators
- Compliance officers
- Billing staff
- Medical office managers
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