Effective Compliance Program Components

 The Department of Health and Human Services Office of the Inspector General (OIG) has issued a voluntary Compliance Program Guidance for individual and group practices. The OIG created this program to prevent fraudulent conduct and reduce the number of erroneous claims submitted to Medicare and Medicaid. The OIG thinks that a healthcare provider can use internal controls to ensure adherence to federal program requirements. The OIG feels that implementing a compliance program shows that a practice is making good faith efforts to submit claims appropriately. They have compiled seven components of an effective compliance program.

* A practice should conduct regular reviews on policies and procedures to ensure they are up-to-date and complete. This benchmarking allows a practice to document the decrease or increase in paid and denied claims. Then, review internal processes to ensure that coding and documentation is being conducted properly - Nursing Home Attorney  Lawyer.

* Once internal reviews have pinpointed risk areas in a practice, a set of written "practice standards" should be developed and implemented. This will establish tighter internal controls to reduce errors and fraudulent claims.

* A practice should designate a Compliance Officer or contact who will be responsible for developing any corrective measures, if needed, for all compliance related areas.

* Training is an essential element of the Compliance Program. An appropriate education program includes elements of coding, billing, federal statutes, regulations, and aspects of the Program.

* If a practice detects a possible violation, it should determine how to respond to the offense and develop appropriate corrective initiatives. An example of a corrective action is returning any over-payments.

* Establishing open channels of communication between the physicians and compliance personnel helps to eliminate problems from occurring. This can be an informal function, such as the implementation of an "open door" policy.

* A practice should ensure that their employees understand the consequences of not following the Compliance Program. It is essential that a practice enforce disciplinary standards through guidelines that are explicitly stated.

Comments

Post a Comment

Popular posts from this blog

The Truth About Tobacco and Marijuana

WHAT ARE THEY? Substances Are non food, mood-altering substances that are not deemed medically necessary but that are used in an effort to escape from the problems of life, to get a dreamy feeling, or a sense of well-being or of elation. Tobacco-An addictive substance containing toxic substances with eventual harmful effects when ingested into the body. Tobacco contains thirty different substances such as nicotine, arsenic, alcohol and ammonia. Nicotine is one of the oldest, the most widely used, and, in the same amounts, stronger and more addictive than cocaine. The euphoric effect of nicotine is the same as morphine and cocaine. According to one researcher, "tobacco contains as nice a collection of poisons as you will find anywhere. The tobacco used in pipes and cigars contains more nicotine, more cancerous tars, and produces more dangerous carbon monoxide gas than that used in cigarettes. Marijuana (Also known as pot, reefer, grass, ganja, or weed) has been the focus of much co...
Read more
 The time needed to create a proposal depends on how complex the proposal is, how many people need to participate, and how organized everyone is. Things to consider for the schedule are: Research time First draft writing time First draft review time Second draft and incorporating comments Final review Changes from final review Final proofread of all pages Production of PDF and/or printed proposal If the writer starts with the needed information in hand, the research time will be negligible. If the writer must collect all the data from multiple individuals, the research process will obviously take a while. If you have handed the writer an outline for your proposal, that will make writing the first draft more efficient than if the writer needs to "wing it." Here again, a pre-designed proposal kit can help with ideas and examples about the best organization for successful proposals. Every proposal needs at least one review and one final proofread. For a very simple p...
Read more

Marijuana Use May Increase Risk of Testicular Cancer

Smoking marijuana may increase men's risk of testicular cancer, a new study from the University of Southern California (USC) finds. This new study discovered that men who smoked weed or marijuana were twice as likely as men who had not to get a dangerous form of the disease. If you don't know, testicular cancer is the most common form of cancer diagnosed in men under the age of 45. It's also on the rise, says Scott Eggener, MD, a cancer surgeon at the University of Chicago who has studied the trend. There was a study released earlier this year that showed marijuana use is up, with 1 in 10 teens now smoking marijuana at least 20 times a month. The USC study compared a group of 163 men with testicular cancer to a similar group of 292 healthy men who were questioned about recreational drug use. The researchers of California discovered those men who used marijuana had a two-fold increased risk of testicular tumors and, more specifically, tend to affect younger men and are diffi...
Read more