A compliance plan should address seven elements that are based upon the Federal Sentencing Guidelines. TheOffice of Inspector General has developed numerous compliance guidances over the past 17 years. For outpatient therapy practices the OIG’s Compliance Program Guidance for Individual and Small Group Physician Practices (published in the Federal Register: Vol. 65, No. 194 / Thursday, October 5, 2000 / Notices) sets forth guidance for a compliance program based upon the seven elements, and suggests that small providers can scale their program appropriate to the size and resources.
Compliance Plan Seven Elements
Many practices that have a chart review program in place may be surprised to see that this activity does not qualify as the sum total of an effective compliance program. So what are the seven elements?
- Conducting internal monitoring and auditing;
- Implementing compliance and practice standards;
- Designating a compliance officer or contact;
- Conducting appropriate training and education;
- Responding appropriately to detected offenses and developing corrective action;
- Developing open lines of communication; and
- Enforcing disciplinary standards through well-publicized guidelines.
The OIG provides the following guidance to small practices
…. unlike other guidances issued by OIG, this guidance for physicians does not suggest that physician practices implement all seven components of a full scale compliance program. Instead, the guidance emphasizes a step by step approach to follow in developing and implementing a voluntary compliance program. This change is in recognition of the financial and staffing resource constraints faced by physician practices. The guidance should not be viewed as mandatory or as an all-inclusive discussion of the advisable components of a compliance program. Rather, the document is intended to present guidance to assist physician practices that voluntarily choose to develop a compliance.
Although the language used in this guidance (2000) suggests that a compliance program is voluntary, the Affordable Care Act (ACA) mandated the implementation of a compliance program as a condition of payment with Medicare. Although CMS has yet to publish guidance for this ACA mandate, best practice is to use what is available from the Office of Inspector General.
Does your practice have a compliance program based on the seven elements? Is the compliance program effective? Is your compliance program based upon a risk assessment?