Home Health & Hospice Week

Don’t overlook your ACA compliance plan responsibilities.

Ready to get your compliance program off the ground? Now you’ve got a little help from some very knowledgeable sources, thanks to a new webinar from CMS and the OIG.

Background: The Affordable Care Act re-quires that providers establish a compliance program as a condition of enrollment in Medicare or Medi-caid, said Lauren Gillooly Robbins, manager for provider education support services with Palmetto GBA during the Centers for Medicare & Medicaid Services’ recent webinar, "Affordable Care Act Pro-vider Compliance Programs: Getting Started."

Of course, the ACA was finalized in 2010 and you may be wondering whether CMS has set an enforcement date for the provider compliance plan. "Let me answer the million dollar question," Rob-bins said. "There is no date yet. We don’t know when there might be a date, and we’re very sorry, we don’t have that information for you today."

However, it’s certainly in your best interest to get started ahead of time. First, this is important so you aren’t scrambling to comply when the government finally does set a date, but it’s also helpful so you can ensure that you’re reporting your services ethically and that you have fewer billing mistakes. This will ultimately lead to faster claims payment and less scrutiny from auditors, Robbins said.

Although CMS and the HHS Office of In-spector General don’t offer a template to create your compliance plan, there is some guidance you can follow to ensure that you are within the guidelines, said physician and attorney Julie Taitsman, chief medical officer with the OIG, during the webinar. She recommends seven elements that can help you craft an effective compliance program:

1. Written Policies and Procedures. The best way to clarify and share your agency’s compliance plan is to put it in writing. "These written policies, procedures and standards should be composed with guidance from the compliance officer and compliance committee," Taitsman said. All employees should review the standards within 90 days of being hired and then annually thereafter, she advised.

The written compliance plan should include your code of conduct, commitment to compliance, and treatment of patients and employees, she said. In addition, the plan should outline the compliance responsibilities for all of your staff members, as well as the following items, Taitsman said:

• How and when employees will be trained
• Operation of the compliance program, in-cluding the compliance reporting structure
• Reporting mechanisms
• How investigations will be conducted
• How you will resolve any issues uncovered
• Monitoring of the compliance plan
• Auditing to ensure that the plan is being followed

2. Compliance Program Oversight. Once the compliance plan has been completed, your work is not done — in fact, it’s just beginning. You need "to establish who will oversee the compliance program as the organization’s watchdog," Taitsman said. "A compliance officer and/or compliance committee needs to be put in place," and they should report directly to senior management.

These employees should create policies and procedures, attend staff meetings, monitor compliance performance, enforce standards and evaluate whether corrective actions are handled appropriately.

3. Training and Education. "Training your staff is one of the most important elements of your compliance plan to ensure that staff is aware of the expectations and standards," Taitsman said. You may know how to train new staff members, but some providers are flummoxed about how to handle the annual updates.

"The refresher training should re-emphasize the organization’s code of conduct," Taitsman said. "Training should, when appropriate, use actual compliance scenarios and/or investigations of non-compliance as examples of risks that employees and managers may encounter." Using interactive real-life scenarios allows the employees to take away the lessons in a more valuable way, she said.

4. Open Lines of Communication. Encour-aging your staff members to speak up if they see a compliance issue is essential for any effective program, Taitsman said. Some bigger organizations will have a toll-free number that staffers can call to report infractions, while smaller providers have to work harder at fostering open-door policies to encourage employees to report issues they see. "If you don’t receive many reports, don’t assume that there are no problems," Taitsman warned.

You can create reporting mechanisms like an email or internet-based form, an anonymous drop-box, or an in-person appointment. No matter what you choose, you should make sure that every staff member knows the reporting method so they can quickly access it when necessary.

5. Auditing and Monitoring. Although you might interchange these two terms, there is a big difference between auditing and monitoring, Taitsman said. Monitoring refers to regular reviews on a day-to-day basis to confirm that the organization’s operations are continuing to include ongoing compliance. Auditing, on the other hand, "includes formal reviews of compliance with a particular set of standards as base measures," Taitsman says.

During audits, your compliance staff will periodically evaluate the compliance program via desk audits, on-site visits and internal and external examinations, with a report afterward that includes the findings. You should perform this at least once a year, or more often as appropriate, she advised.

Common problematic compliance areas in-clude coding and billing errors, as well as hiring people who are statutorily excluded from participating in federal programs like Medicare and Medicaid, Taitsman said. Compensation surrounding marketing and referral sources is a common home care and hospice trouble spot, experts say.

6. Consistent Discipline. If you find anything amiss during your monitoring and auditing activities, you’ll need to have a plan in place that enforces discipline, Taitsman advised. "Discipline must be dealt with timely and enforced consistently," she said. "Disciplinary policies must be clearly written and describe expectations and consequences for non-compliant behaviors. They should be widely publicized and reviewed at least annually for the staff."

7. Corrective Action. At some point during your tenure under a compliance plan, you’re sure to find an issue, and you must have a plan in place to correct it. For instance, you may need to refund an overpayment you’ve identified, or create a disciplinary action against non-compliant employees. Ensuring that you follow through with the corrective action is the final step to confirm that your compliance plan is solid.