E/M Coding Alert - 2014 Issue 8
Compliance: These 5 Questions Solidify Your Compliance Savvy
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Article Overview
This article reviews five practical compliance topics relevant to Part B practices, using a question-and-answer format to examine internal policies, staff-related screening decisions, compliance plan maintenance, documentation and reporting concerns, conflict-of-interest procedures, and payer contract issues. It is aimed at practice administrators, physicians, compliance officers, and billing/coding staff who want a broad refresher on operational compliance expectations and related regulatory considerations.
Why This Topic Matters
Compliance programs can become outdated or incomplete over time, and small gaps in policy, documentation, or billing processes can create audit and contract risks. This article helps readers assess whether common office practices still align with current compliance expectations.
Article Sections
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Know Whether to Screen New Staff members
Discusses workplace screening considerations for prospective or current employees in a medical practice, including policy planning and operational concerns.
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Update Your Compliance Plans
Reviews whether a purchased compliance plan remains adequate and emphasizes the need for ongoing integration, monitoring, and training within the practice.
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Know the Codeable Services
Addresses documentation and reporting issues tied to prescription-related services, along with related coding and quality reporting topics.
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Identify Conflicts of Interest
Covers conflict-of-interest policies, disclosure procedures, and internal controls for practice personnel with outside business interests.
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Know Your Contracts
Explains compliance considerations involving payer contracts, patient billing, claims submission, and allowable amounts in participating and non-participating situations.
What You Will Learn
- How medical practices can evaluate staff screening policies
- Why a compliance plan must be maintained beyond initial purchase or adoption
- What broad documentation and reporting issues can arise with prescription-related services
- How conflict-of-interest disclosure procedures are typically structured in a practice
- What general compliance issues affect billing under payer contracts
Who Should Read This
- Physicians
- Practice administrators
- Compliance officers
- Billing and coding staff
- Medical office managers
Codes Discussed
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