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compliance programs
FRAUD. ABUSE. COMPLIANCE. These
words can mean the difference between a financially stable practice and one in
fiscal disarray.
While the majority of medical providers bill
carriers and payors for the level and type of services provided, documenting
these services according to national standards can be time consuming and less
than perfect. On the appeal level, medical providers are given the chance to
verbally defend the provision of services as billed. However, Medicare's and
Medicaid's policy of "recoup the overpayment now and allow you to defend
yourself later" can leave your practice with significant cash flow shortages for
up to two years.
Your chances of being audited are increased if you
exceed the established norms or submit claims on Medicare's "Alert
List."
The OIG Work
Plan is updated each year to target specific services and procedures. Included
for 2006 are:
- Welcome-to-Medicare services
- Care Plan Oversight
- Cardiography and Echocardiography Services
- Ordering Physicians Excluded from Medicare
- Physician Pathology Services
- Wound Care
- Independent Diagnostic Testing Facilities
- Physical and Occupational Therapy Services
- Therapy Services Provided by Comprehensive Outpatient Rehabilitation
Facilities
- Billing Service Companies
- Part B Mental Health Services
Our Certified Compliance
Professionals (CPC's) will identify areas in your practice that put you at risk
for a Whistleblower Lawsuit or HIPAA fines.
First, we
perform a compliance audit using a checklist of OIG recommended risk areas.
Using these "key risk areas", we carefully examine all of your current
operations, policies, procedures, documentation, and code data looking for
existing and potential violations of the law. An initial pre-payment chart audit
by our CPC's is also performed at this time.
Based on our findings,
we provide you with a detailed written analysis. We then help you develop,
implement, and maintain a compliance plan with a vigilant checks-and-balances
program that will keep your practice compliant with the laws. The existence of
an active and ongoing medical compliance plan is viewed as a sign of good faith
and may decrease the likelihood of exclusion.
To assist you with your medical
compliance plan, we can:
- Provide a customized OIG compliance program for your practice.
- Install compliance checks and balances into existing business
office/billing policies and procedures.
- Write policies and procedures addressing the compliance committee, the
compliance officer, ongoing training, handling complaints and investigations.
- Perform recommended periodic external audits.
- Provide ongoing training.
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