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Within the world of healthcare, compliance is an important component. Viewed as “preventive medicine,” its purpose is to identify small problems before they become big ones, enabling an organization or practice to correct deficiencies before they are discovered by auditors. Rather than waiting until problems start to get out of control and regulatory agencies begin to impose penalties and possibly fines, it’s best to hire the services of a healthcare compliance programs lawyer. By doing so, you can be proactive in correcting deficiencies and ensuring your practice will be leading the way in patient care as well as compliance.
By identifying the appreciable risks within a practice or organization, the chances of committing costly mistakes can be greatly reduced. As a compliance plan is developed and then implemented, practical policies and procedures can be put in place throughout each department. As a result, staff can be better trained through continuing education programs and workshops. In most cases, policies and procedures tend to focus on such important matters as billing, documentation, and the requirements of Medicare and other third-party providers and payors.
Due to the compliance process being so complex, it’a virtually inevitable that legal dilemmas will occur. When this happens, it’s more important than ever to consult with a healthcare compliance lawyer before things begin to unravel. One of the most common problems practices and organizations face revolve around the False Claims Act. With numerous timely amendments having been made to it in recent years, practices face additional obligations when it comes to repaying identified overpayments. With various legal requirements surrounding the identification of overpayments, a knowledgeable healthcare compliance programs lawyer can guide a practice or organization through the complicated process of determining how and when to carry out repayments.
Essential Elements of a Compliance Program
Even though compliance programs are largely voluntary for practices and organizations, they nevertheless need to possess certain elements to be successful. According to the U.S. Department of Health and Human Services, some of the most important elements include designating a compliance officer and compliance committee, conducting appropriate training and education for staff, responding quickly to offenses and taking corrective action, having open lines of communication, and enforcing disciplinary standards. By identifying the areas of a practice or organization that have the most urgent needs, it will be much easier to have key personnel gain a greater understanding of how services are provided, documented, and billed.
Who Performs Internal Compliance Audits?
To ensure an organization gets the best results during a compliance audit, it’s highly recommended that they be performed under the direct supervision of an attorney. When done in this manner, the organization or practice can have peace of mind knowing its work falls under attorney-client privilege. By being able to provide your lawyer with all initial drafts of compliance rules and regulations, you can be sure everything will be thoroughly reviewed prior to implementation. In addition to this, a lawyer can recommend the use of an outside auditor for the compliance audit. Although it’s widely acknowledged that a member of the organization or practice who has specific coding or billing knowledge could perform the audit, compliance programs lawyers know an outside auditor will provide a fresh set of eyes on matters, which can often be the key to ensuring billing is done correctly.
The Internal Reporting System
When an organization implements a compliance program, one of the most important aspects involves setting up an internal reporting system. Examples of this can include a hotline, suggestion box, or other means of confidential communication. In most organizations that conduct employee training sessions, all who attend usually sign statements agreeing to report all compliance matters. While this may not sound important at first, the fact is it provides significant legal protection for the practice, since employees are required to bring compliance matters to the internal compliance officer rather than to an outside entity.
While healthcare compliance rules and regulations can be some of the most complex of any industry, it is crucial to ensure your practice is abiding by all of them in a professional manner. By working with a healthcare compliance programs lawyer, the chances of making critical mistakes lessens tremendously.