Why a Compliance Program?
A compliance program helps providers promote adherence to statutes and regulations applicable to the Federal health care programs such as Medicare, Medicaid and Tricare. The Affordable Care Act has mandated the implementation of a compliance program. While CMS has only recently provided guidance for Skilled Nursing Facilities, the OIG has cautioned that providers should model a compliance program in accordance with the OIG Compliance Guidances.
The goal of a compliance program is to provide a tool to strengthen the efforts of health care providers to prevent and reduce improper 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.
Compliance programs also provide benefits by not only helping to prevent erroneous or fraudulent claims, but also by showing that the therapy practice is making additional good faith efforts to submit claims appropriately. Providers should view compliance programs as analogous to practicing preventive medicine for their practice. Therapy practices that embrace the active application of compliance principles in their practice culture and put efforts towards compliance on a continued basis can help to prevent problems from occurring in the future.
A compliance program also sends an important message to a physician practice’s employees that while the practice recognizes that mistakes will occur, employees have an affirmative, ethical duty to come forward and report erroneous or fraudulent conduct, so that it may be corrected.
Compliance Resources for the Therapy Practice
Nancy Beckley & Associates offers a Gold Membership Program that organizes a variety of compliance resources for the therapy practice. Take a moment to review the topics on our proprietary Rehab Compliance Knowledge Base.
Effective Compliance Program Elements
This compliance program guidance for individual and small group physician practices contains elements that provide a solid basis upon which a small to medium sized therapy practice can develop and scale a compliance program. We have updated these elements to be consistent with the 2017 Measuring Compliance Program Effectiveness: A Resource Guide, a joint publication of the Health Care Compliance Association and the Office of Inspector General.
- Standards, Policies and Procedures
- Compliance Program Administration
- Screening and Evaluation of Employees, Physicians, Vendors & Other Agents
- Communication, Education, and Training on Compliance Issues
- Monitoring, Auditing and Internal Reporting Systems
- Discipline for Non-Compliance
- Investigations and Remedial Measures
These components are similar to those contained in previous guidances issued by the OIG. However, unlike other guidances issued by OIG, this guidance for physicians and small practices does not suggest that such groups 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 compliance program.