E/M Coding Alert - 2016 Issue 20
Compliance: Lack of a Practice Compliance Program Puts You at Risk
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Article Overview
This article discusses the importance of compliance programs for healthcare practices, with emphasis on an OIG policy statement released in 2016 and its impact on permissive exclusion risk. It is aimed at providers, practice managers, compliance officers, and billing/coding professionals who need a broad understanding of compliance planning, cooperation, self-disclosure, and operational safeguards such as HIPAA, audits, staff training, and legal counsel. The article also touches on corporate integrity agreements and the general factors the OIG considers when evaluating whether exclusion or other remedies are appropriate.
Why This Topic Matters
Healthcare organizations can use this article to understand why compliance infrastructure is treated as a core operational issue and how federal oversight may view the presence or absence of a compliance program. It is relevant to practices looking to reduce regulatory risk and improve internal controls around privacy, training, monitoring, and documentation processes.
What You Will Learn
- Why compliance programs are important in healthcare practices
- How an OIG policy statement relates to permissive exclusion risk
- General factors that can affect organizational responses to fraud or misconduct concerns
- Basic elements commonly included in a practice compliance plan
- Operational areas such as HIPAA, audits, staff education, and monitoring
Who Should Read This
- Healthcare providers
- Practice managers
- Compliance officers
- Medical office administrators
- Billing and coding professionals
- Healthcare attorneys
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