E/M Coding Alert - 2013 Issue 7
Regulations: Will Your Compliance Plan Make the Grade? Find Out What The ACA Requires
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Article Overview
This article discusses the Affordable Care Act’s compliance-program requirement in the context of Medicare, Medicaid, and CHIP participation, along with the status of CMS rulemaking and the practical need for interim compliance planning. It is written for provider organizations, especially physician groups, that need to understand the broad regulatory expectations and the kinds of compliance-program elements discussed by industry experts while waiting for final federal guidance.
Why This Topic Matters
Organizations participating in federal health care programs need to understand how compliance-program expectations may affect enrollment and reenrollment. The article highlights why the issue matters for physician groups, how CMS and HHS rulemaking status affects readiness planning, and why a structured compliance framework remains important even before final guidance is issued.
Article Sections
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ACA compliance-program requirement
Introduces the statutory compliance-program requirement and its relevance to providers and suppliers participating in federal health care programs. Discusses the broad policy context and who may be affected.
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Stay tuned for CMS final rule
Summarizes the status of CMS rulemaking and the uncertainty created by the lack of final federal guidance. Notes the role of CMS and related oversight entities in shaping the eventual framework.
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Use Y2K compliance model for now
Explains the article’s interim planning approach and references older compliance-program guidance as a temporary roadmap. Addresses the need to account for changes in practice structure and billing operations.
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The 2000 guidelines offered seven components
Lists the broad elements described in the older compliance guidance and frames them as foundational program components. Focuses on general compliance-program structure rather than specific implementation details.
What You Will Learn
- How the ACA relates to compliance-program expectations for federal program participation
- Why CMS rulemaking status affects provider readiness
- What broad areas are commonly included in a structured compliance plan
- Why physician groups are advised to tailor compliance programs to their own operations
Who Should Read This
- Physician groups
- Emergency department groups
- Compliance officers
- Practice administrators
- Health care legal and regulatory professionals
- Medical billing and coding professionals
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