Home Health & Hospice Week

Overlooking this element of compliance could put you at greater risk than you imagine.

When was the last time you updated your compliance program? If it's been a long time - or worse, never - you owe it to yourself to put the issue on the top of your to-do list.

Failing to do so could make all your previous compliance efforts for naught - and put you at considerable risk in the event of an investigation. And it looks like home care investigations will abound in the coming year, with the HHS Office of Inspector General more than doubling its home health agency workload in fiscal year 2004 and setting out numerous durable medical equipment areas for study (see related stories, " Fraud & Abuse").

"Compliance is an ongoing process," says consultant Patricia Trites with Healthcare Compliance Resources in Augusta, MI. With the rules of the game constantly shifting and changing, providers have to keep pace. The OIG's compliance guidance says providers need to periodically update their compliance plans, Trites points out.

Health care attorney Elizabeth Hogue urges home care providers "to make certain that their corporate compliance plans are up-to-date and that they actually use them."

"Everyone is so hyped on HIPAA, they've forgotten this," Trites says, but it's essential to review your compliance plan at least once a year. And if something "special" comes up, such as a significant change in the law or a particularly onerous compliance incident in your organization, dust off your plan at that point as well, she suggests.

Additionally, amend your plan accordingly if an audit reveals billing and/or documentation problems, counsels attorney Robert Wanerman with Reed Smith in Washington. If the feds notice that you're making the same mistakes over and over, and haven't addressed the issue in your compliance program, it'll look to them like you don't care about compliance.

There are so many compliance resources out there that "a reasonably diligent provider can't avoid the stuff," he points out. That means there's no excuse for not keeping up-to-date.

And lack of resources isn't a good excuse for neglecting compliance, warns attorney Jeff Schneider with Hogan & Hartson in New York City. "Don't be penny wise and pound foolish," Schneider insists. Compliance must be a high priority to make sure you are claiming all the reimbursement you're entitled to, don't run into overpayments down the line, and avoid fraud and abuse charges.

Consider these tips when updating your compliance plan:

1. First examine any changes to laws and local policies that have come down the pike since your last update, experts agree. Then have a look at any findings from recent audits, and make sure they're addressed in your plan, Wanerman offers.

2. Include monitoring as well as training as an important part of your compliance efforts, Schneider recommends. "Monitoring is the best educational tool" since employees learn concepts better in practice rather than sitting in a lecture, Schneider tells Eli.

3. Imagine you're using your plan to defend yourself in an investigation. "Put yourself in the shoes of the person on the other side of the table," Wanerman says. Would you appear to have your bases covered, or would you look more like a kid in the outfield hoping the ball doesn't come his way?

4. Although not necessarily as part of their compliance plans, Hogue counsels HHAs to establish both clinical pathways and policies and procedures for admissions and discharges to head off fraud charges before they start.