Creating a compliance plan is probably the most robust way to protect yourself against the overpayment penalties brought about by the ACA’s expansion of the False Claims Act.
The ACA already requires a wide range of providers to establish compliance and ethics programs if they want to continue in the Medicare and Medicaid programs. The Office of the Inspector General’s (OIG) “Seven Fundamental Elements of an Effective Compliance Program” is an incredible place to start.
Let’s see what these elements are and how they help you more effectively engage your team.
Implement standards and procedures: When establishing a compliance program, it’s essential to accommodate the practice’s unique risks. The key is to not shelf the program – they should be an everyday part of practice operations. The OIG will take note.
Designate a compliance officer: This officer must have extensive knowledge of your practice’s operations and should educate other employees, update doctors, and correct violations.
Train and educate: Compliance education should be provided for every employee, from initial and new employee training to annual ‘update’ courses.
Monitor and audit: Periodic chart audits do wonders to ensure your practice’s documentation supports the levels of service billed. Documenting audit results should also be integral to your compliance plan.
Respond: Document any problems you’ve identified and take engaging, decisive approaches to correct them.
Open lines of communication: Create an easy process to reporting fraudulent behavior at your practice. These reports should be anonymous on both ends, and communication mechanisms for filing a complaint should be very specifically delineated.
Enforcement through discipline: Make public disciplinary standards to your employees and document disobedience. You should be prepared to take disciplinary actions on violators, including reprimands, probation, demotion, suspension, and possibly termination.
How Can You Engage Your Staff?
The OIG’s tips to creating a compliance program promote transparency at your medical practice, which is an obvious plus for keeping lines of communication open among staff members.
Using your compliance program is an excellent way to communicate expectations to your staff as well, discussing goals for individual employees and the practice as a whole. Or you can incentivize the most cooperative employees at your practice, perhaps via expanded responsibilities and a possible title change.
A compliance program can even help you spot problems you may not have noticed among staff members before, e.g., avoidable miscommunications, dishonesty, or clunky work processes. Or you can even gamify the process, as seen here.
Have you created a compliance program yet? What do you think of the ACA in general? Share your thoughts in the comments below.