Compliance Program Essential for Medical Practices and Facilities

Compliance Program Essential for Medical Practices and Facilities

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Why Is a Compliance Program Important?

You need to get your coding, documentation, productivity stats and revenue integrity all monitored. Thanks to the availability of advanced data analytics, noncompliant physician profiles can be identified easily. Without a serious compliance program in place, False Claims Act liability and increased scrutiny of your practice for law enforcement are all possibilities. It is scary but essential to note that in the first half of 2014, federal audit recoveries amounted to $3.1 billion, the result of false healthcare program claims. This shows that regulatory compliance is important even if it saps resources.

Providers of medical outsourcing services are careful to ensure regulatory compliance. That is why outsourcing labor and time intensive processes such as medical billing and coding often proves to be more efficient and cost-effective than performing these in-house.

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Important Aspects of Compliance Here are some of the aspects that need to be incorporated for an effective compliance program. These can be carried out in-house or through the outsourced medical services of a medical billing and coding company.

The compliance guidance plan of the Office of Inspector General contains some vital elements that must be implemented.

It is important to carry out regular audits involving assessment of risks. This can help identify areas to work on with high risk and enable them to be addressed first. Benchmark audits can help review small data samples and also help set up a baseline for future audits. In instances where benchmark audits reveal issues, an expanded audit plan may be required. Corrective action must be implemented after the problem is identified, and it must be followed up on. Monitoring and auditing must be a continuous process.

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Payment errorserrors must bebereported, particularly payments were to not  Payment must reported, particularly payments that werethat not entitled come to your practice. The CMS is very firm regarding this and has revealed the self-disclosure. entitledrequirements to come toforyour practice. The CMS is very firm regarding this and

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The Affordable Care Act requires providers as well as suppliers to set up a compliance program containing some primary elements required for enrollment in Medicaid and Medicare as well as CHIP. Medicaid providers meeting some of the criteria are mandated certain compliance certification requirements in Arkansas and New York State.

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You may need to hire a staff member or an outsourcing partner for efficiently leading your practice’s compliance program. Regular self-audits and risk adjustments need to be performed so that potential issues can be promptly identified and rectified. Issues are bound to be there in any healthcare practice.

Finally it is important for the staff of your practice to be trained in identifying and reporting abuse and fraud, if you are handling compliance in-house. The importance of compliance must be understood by every staff member. Training must also be provided in ensuring revenue integrity and avoiding errors.

With medical outsourcing services providing dedicated compliance solutions, it becomes easier for healthcare practices to focus on their core functions and stay clear of penalties.

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About Outsource Strategies International Outsource Strategies International (OSI) is a reputable medical outsourcing solutions provider based in Tulsa, Oklahoma offering advanced medical billing and coding solutions for hospitals, physicians, physicians' groups, clinics and other healthcare entities. Find more details at: www.outsourcestrategies.com

Contact Us 8596 E. 101st Street, Suite H Tulsa, OK 74133 Main: (800) 670 2809 Fax: (877) 835-5442 E-mail: info@managedoutsource.com URL: www.outsourcestrategies.com