tci Medicare Compliance & Reimbursement - 2011 Issue 3
Compliance: 5 Tips Help You Keep Compliance Problems at Bay
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Article Overview
This article discusses physician practice compliance programs and why they matter for avoiding regulatory problems, audit exposure, and internal process gaps. It focuses on broad compliance program design, staff involvement, complaint handling, and ongoing self-review, with references to Medicare, HIPAA, Stark, anti-kickback, and related health care law topics. The piece is aimed at practice leaders, compliance staff, billers, and others responsible for maintaining a practice’s compliance framework.
Why This Topic Matters
Healthcare organizations need a workable compliance program to help identify risks, respond to employee concerns, and stay prepared for audits or regulatory review. The article is relevant to anyone responsible for practice operations, billing integrity, privacy, and legal compliance oversight.
Article Sections
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Introduction
Introduces the topic of practice compliance and the risk of overlooked problems in day-to-day operations.
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1. Draw up and institute a sound compliance plan
Covers the importance of having a formal compliance framework and maintaining it as part of routine practice governance.
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2. Avoid "canned" compliance plans
Discusses concerns about generic compliance materials and the need for practice-specific planning and ongoing updates.
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3. Encourage a culture of compliance
Focuses on staff awareness, shared responsibility, and embedding compliance into practice operations.
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4. Be receptive to employee complaints
Describes complaint-reporting processes, confidentiality concerns, and internal handling of compliance issues.
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5. Police yourself
Addresses internal review, monitoring, and regular self-assessment to help identify and correct issues early.
What You Will Learn
- How physician practices structure a compliance program
- Why customized compliance planning is emphasized
- How staff participation supports compliance efforts
- How practices can handle internal complaints and concerns
- Why periodic self-review and audits are important
Who Should Read This
- Physician practice administrators
- Compliance officers
- Medical office managers
- Medical billers and coders
- Health care attorneys
- Practice owners
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