MEDICAL COMPLIANCE SPECIALIST - PHYSICIAN
If
there is any single body of knowledge necessary for professional advancement
within the medical community, it's a basic knowledge of the laws,
rules and regulations which effect the daily operation of a medical
practice. Without this basic knowledge it can be impossible to make
critical decisions, or in some cases even realize a decision
needs to be made.
This
Course is an in-depth examination of regulatory compliance issues
associated with a physician's practice environment. It offers a broad
base of fundamental compliance knowledge with real-world solutions,
such as: How to bring an existing (or new) practice into regulatory
compliance from an operational perspective, including coding, billing
and reimbursement. During this interactive Course, an actual compliance
plan is created complete with a Policy and Procedure Manual.
Course
Description
This
Course experience brings total emersion in compliance issues
within an interactive group setting, and produces the knowledge, strategies
and momentum for measurable and lasting success.
DAY
ONE provides a general overview of a compliant physician environment
beginning with the OIG recommended Compliance Program for Physicians.
We define the seven compliance program elements, began the construction of a Compliance
Program and explore the operational effects of a compliance program
from inception through the life-cycle of a practice.
DAY
TWO focuses on the coding-billing-reimbursement aspects of a physician's
environment, or what we refer to as: "Where compliance meets
the codes". We explore incident-to regulations, teaching physician
regulations and other OIG identified risk areas of audits and investigations.
We also include an example of a medical record audit and reporting,
study the Provider Self-Disclosure Protocol, 3rd Party Billing
Company Compliance Program and the current OIG Work Plan.
DAY
THREE begins a study and discussion of regulations and statutes.
We examine the processes of regulatory authorities and the more prevalent
laws affecting a physician's environment. i.e. Medicare Modernization
Act, OSHA, CLIA, Anti-Kickback Statute, Safe Harbors, Stark I &
II, Civil Monetary Penalties Law, the False Claims Act and the BBA
of 1997.
DAY
FOUR continues the examination and discussion of regulations and
statutes. We cover HIPAA Privacy and Security, the 2005 Medicare Schedule
revisions, laboratory certifications and the Laboratory Compliance
Program. The fourth day concludes with a review of the completed
Policy and Procedure Manual.
DAY
FIVE is exam day. Three hours are allowed for the exam which consists
of 100 questions.
*Actual
course content is more comprehensive than described here. Please contact
us for a detailed MCS-P Course Outline.
Objectives:
1. Clearly define and explain the guidelines,
regulations and statutes associated with the implementation of a comprehensive
Compliance Program for a physician’s practice. Upon successful completion
of this 
course
the compliance professional will have the knowledge and tools necessary
to design, develop and implement a Compliance Program for any specialty
and any size physician’s practice.
2. Provide a clear understanding of the
seven components of a Compliance Program including Coding, Billing
and Reimbursement issues as well as OIG identified risk areas of audit
and investigations.
3.
Provide fundamental information necessary to assess a practice site
and make appropriate Compliance Program design recommendations.
4. Provide
organizational tools such as forms, compliance project check-lists
flowcharts and worksheets necessary to develop, implement and
maintain a Compliance Program for the life-cycle of the practice.
5. Construct an actual compliance program in class, including a
model Policy and Procedure Manual.
6. Provide a comprehensive overview of compliance related issues
associated with laboratory, radiology, pharmaceutical handling, home
health and hospice services and other operational aspects of a physician's
practice.
Program:
The MCS-P
certification course is offered at various locations throughout the
country. It is a 4-day course, usually scheduled
for Monday thru Thursday, from 8:00am until 6:00pm; approximately
34 hours of classroom instruction with student interaction. A written
exam is scheduled for the 5th day (usually Friday at 9:00am) . Three
hours will be allocated for the exam.
It will be
presented in lecture format with student participation, using examples,
material and data from the provided manual, workbook and accompanying
CD-ROM. By the end of the course, students will have constructed a
model Compliance Policy and Procedure Manual.
Course
Materials:
It
is not necessary to bring CPT, ICD-9, or HCPCS books to class. All
Course materials are provided. Each student will receive the following
materials the first day of class:
