tci Medicare Compliance & Reimbursement - 2016 Issue 5
Compliance: Know the Regulations Like the Back of Your Hand
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Article Overview
This article reviews common compliance issues faced by medical practices and explains why a generic compliance binder is not enough. It discusses whistleblower risk, the need for practice-specific compliance planning, record-signature and attestation topics, and internal procedures for reporting concerns when the compliance process itself may be implicated. The content is aimed at practice leaders, compliance staff, and billing/coding professionals who want a broad understanding of regulatory and operational compliance responsibilities.
Why This Topic Matters
Compliance problems can lead to audits, penalties, and internal reporting failures, so practices need more than a static policy document. Understanding the broad areas covered here helps organizations identify where compliance systems, ethics channels, and record-handling processes may need review.
Article Sections
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Don’t Think You’re Immune to Whistleblowers
Discusses why whistleblower concerns arise and why employee reports of suspected problems should be taken seriously. The section focuses on general compliance risk awareness and reporting behavior.
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A Compliance Plan Alone Won’t Protect You
Explains why a purchased compliance plan may not be sufficient on its own and why practices are expected to assess their own exposure areas. The section emphasizes the need for a plan that is tailored to the organization.
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Identify Conflicts of Interest
Addresses record-signature concerns and the use of attestation-related guidance referenced through CMS and MLN materials. The section also touches on contractor guidance and related documentation practices.
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Show Employees Where to Report Compliance Issues
Describes the importance of having internal reporting paths and protections for employees who raise compliance concerns. The section also notes the relationship between compliance processes, ethics, and codes of conduct.
What You Will Learn
- How whistleblower concerns can affect medical practices
- Why a compliance plan should be tailored to a specific organization
- How record-signature and attestation topics fit into compliance oversight
- Why internal reporting options and ethics processes matter in a compliance program
Who Should Read This
- Medical practice administrators
- Compliance officers
- Billing and coding staff
- Physicians and group practice leaders
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