In a highly regulated, high-risk industry like healthcare, regulatory compliance is especially important. Healthcare regulatory compliance is the process of following rules, regulations, and laws that relate to healthcare practices. Most healthcare regulatory compliance issues relate to patient safety, the privacy of patient information, and billing practices.
Every physician deals with confidential health information. Consequently, every physician will need to include compliance with the Health Insurance Portability and Accountability Act (HIPAA) as part of its compliance program. The HHS Office of Civil Rights (OCR) is charged with implementing and enforcing the HIPAA privacy and security rules, and it has provided volumes of guidance on compliance with those rules.
Regulatory compliance in healthcare aids physician practices to avoid trouble with government authorities. An effective healthcare compliance program can identify problems and find solutions to those problems before a government agency finds the problem. An effective healthcare compliance program can also mitigate against the imposition of sanctions, or financial penalties that might otherwise be imposed on physician practices.
The creation of compliance program guidances is a major initiative of the OIG in its effort to engage the private health care community in preventing the submission of erroneous claims and in combating fraudulent conduct. According to the OIG, a well-designed compliance program can:
- Speed and optimize proper payment of claims;
- Minimize billing mistakes;
- Reduce the chances that an audit will be conducted by HCFA or the OIG; and
- Avoid conflicts with the self- referral and anti-kickback statutes.
The incorporation of compliance measures into a physician practice should not be at the expense of patient care, but instead should augment the ability of the physician practice to provide quality patient care.
Each physician practice can undertake reasonable steps to implement compliance measures, depending on the size and resources of that practice. Physician practices can rely, at least in part, upon standard protocols and current practice procedures to develop an appropriate compliance program for that practice.
Conducting Appropriate Training and Education
Education is an important part of any compliance program and is the logical next step after problems have been identified and the practice has designated a person to oversee educational training. Ideally, education programs will be tailored to the physician practice’s needs, specialty and size and will include both compliance and specific training.
There are three basic steps for setting up educational objectives:
- Determining who needs training (both in coding and billing and in compliance);
- Determining the type of training that best suits the practice’s needs (e.g., seminars, in-service training, self-study or other programs); and
- Determining when and how often education is needed and how much each person should receive.
Training may be accomplished through a variety of means, including in-person training sessions (i.e., either on site or at outside seminars), distribution of newsletters, or even a readily accessible office bulletin board. Regardless of the training modality used, a physician practice should ensure that the necessary education is communicated effectively and that the practice’s employees come away from the training with a better understanding of the issues covered.
There are two goals a practice should strive for when conducting compliance training: (1) All employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations; and (2) each employee will understand that compliance is a condition of continued employment.
Concierge Healthcare Attorneys LLC is intent on helping physicians, and group practices avoid the maze of regulatory compliance issues in healthcare. I have served as a compliance officer, have developed compliance programs, conducted in-service training, and have written educational documents for physicians on Fraud and Abuse, and HIPAA. Using in-depth knowledge of the governing laws, our concierge law firm can help with policy development, transactional matters, as well as the addressing of potential infractions of the law. Whatever your circumstances require, we’re here to be your compliance lawyers.
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