What can a Compliance Program do for your practice?

The foundation of any comprehensive Compliance Program is a clear understanding of the laws and regulations which influence and guide the operation of a medical practice and how these laws affect daily decisions. Without this understanding, critical staff members are in a constant emergency mode, "putting out fires" instead of having in place a proper plan to methodically deal with regulatory impact.

A compliance Plan which is not working can cause undue stress, staff burnout, affect patient care and can also have a direct, negative impact on the bottom line. But when properly conceived and implemented:

• A Compliance Program may provide a protective shield to the physician against fraudulent and erroneous conduct. It demonstrates a focused effort to ensure appropriate operating procedures from patient in-take through claims filing that may reduce the risk of non-compliance with Federal healthcare statutes and regulations.
  
  
• A Compliance Program can further reduce the risk of qui tam suits, as personnel are required to abide by strict policies of compliance within the practice environment and are required to report any suspected compliance violations to the practice management. If an employee is required to report questionable activity they may be deterred from reporting alleged behavior to Federal authorities.
  
  Qui tam or whistle-blower cases continue to be a threat to the physician's practice. The Department of Justice (DOJ) has reported approximately 4,000 cases filed since 1986 with recoveries exceeding $6 billion. Recoveries exceeded $1 billion with 300 cases filed for the fiscal year ending September 30, 2002, with relators recovering more than $160 million.
  
  
• A Compliance Program addresses issues of coding and billing, and establishes monitoring procedures for the life-cycle of the practice. Correct coding and billing procedures can increase revenue to the practice while reducing possible liability associated with incorrect coding practices.
  
  
• A Compliance Program addresses education and training for providers and personnel, which is essential to maintain assurances of an internal knowledge base that aligns with current guidelines, statutes and regulations. The constant changes in the healthcare industry require continued education and training for the new employee and for employees that have been with the practice for many years.
  
  
• A Compliance Program can improve the physician's ability to provide quality healthcare to their patients by functioning within a clinical environment that operationally supports the physician while delivering patient care.

Medical Compliance Training provides comprehensive staff training and certification in the analytical methods used by, and the resources available to, a modern regulatory compliance professional. This includes design, development and implementation of a Compliance Program from inception through life-cycle maintenance.

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