Home Health & Hospice Week

Crucial: Hold staff accountable for their documentation.

With so many urgent issues demanding your attention — PDGM prep, OASIS-D transition, compliance with the still-new CoPs, and on and on — letting a rigorous and updated compliance plan fall by the wayside is extremely tempting. But the result can be audits, government investigations, costly whistleblower lawsuits, and worse.

Establishing a compliance program with an internal auditing component is one way of catching potentially huge errors before they get out of hand. “A compliance program is really intended to develop and implement internal controls and procedures that promote adherence to statues and regulations for federal health care programs, private insurance program requirements,” says Terry Fletcher, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California. “The program will strengthen efforts to prevent and reduce improper conduct and improve quality care to patients.”

Use these expert suggestions from Fletcher to start or update a written compliance manual and build an entire compliance program — complete with auditing check-ins.

Formulate A Compliance Program, Manual

A compliance manual is the biggest thing you should start with — like a recipe, it gives you the guidance (and documentation) you need to follow to ensure consistency and accuracy.

First things first: Make a list of what you want to implement in your program and how you want to address it, Fletcher says. This can include the development of a code of conduct, as well as putting policies and procedures in writing.

Next, appoint a staff member as a compliance officer to monitor your agency’s efforts.  Depending on your size, the compliance effort should really be monitored by a team, so various employee roles and perspective are represented.

The team should include reps from different employee types such as clinicians, managers, billers, etc. And “an administrator also needs to always be a part of that conversation,” Fletcher says.

When selecting clinicians, choose someone who has recently passed an audit and is pretty compliant in their documentation efforts, Fletcher says. Otherwise, behaviors that you’d like to see change may be upheld.

Education Is Crucial

The significance of communication really comes into play when making sure everyone is on the same page. While you or your new compliance officer or team may get frustrated or exasperated with employees who aren’t meeting your expectations, it’s unfair to do so unless they fully understand your expectations.

Focus on ethics in order to ground employee understanding in why you’re making changes, as well as detailing agency policies and procedures.

“Develop accessible lines of communication such as staff meetings regarding fraudulent or erroneous conduct issues,” Fletcher says. And devise an agency-wide communication tool to help keep employees updated regarding compliance activities, “and that really needs to be refreshed,” she adds.

Prioritize the enforcement of disciplinary standards, to ensure employees are aware that compliance is treated seriously and violations will be dealt with consistently and uniformly, Fletcher adds.

Plus: Often, a little training can go a long way to avoid not just an audit, but major reimbursement troubles.

Be Consistent

Formulate appropriate responses to detected violations by investigating allegations and having a plan to disclose incidents to the appropriate government entity.

If you find blatant billing issues, “there’s a provision within the Medicare bylaws that says that you have to self-report,” Fletcher says. “It does get a little bit ugly, so you want to make sure you’ve got procedures and policies in place to deal with that,” Fletcher says.

Internal Or External Are Both OK Choices

When it comes to checking in on your progress, the who matters a lot less than the how or when.

“When you talk about audits, not only can you do them internally, as long as you’ve got the staff who understands what audits should look like and how to perform them, but also you can hire somebody externally,” Fletcher notes. “Make sure you get references, information on them, and find out how successful they’ve been in their auditing processes.”

If you or an external auditor do find something amiss, make sure you have processes in place to evaluate your claims submissions and what’s appealed, as well as a plan to deal with any clinicians who are noncompliant with their documentation, she says.

Your basic recipe for a response? “Identify, reprimand, education, follow up, reprimand again, continue education,” Fletcher says.