Medicare Compliance & Reimbursement

There's no better job security for billing staff than being able to prove you are current in billing and coding guidelines -- and that you're making more money because of it. Keeping up with your compliance plan is where it all begins.

Once a year, if not more often, you should review your plan to make sure it's current and compliant. Consider these five expert steps to keep your compliance program is up to speed:

1. Create a compliance calendar. You should define and prioritize activities that are date-specific relative to your compliance plan. Assign activities such as chart reviews, code updates and fee updates to the appropriate months and keep this calendar with your program so you can refer to it throughout the year.

2. Keep a compliance checklist in the front of your compliance manual. Once you have your timeline defined, the next step is documenting your activities. Have a spreadsheet or checklist where you can record dates and activities as they occur.

• 9/30/11 - Updated ICD-9 codes
• 12/28/11 - Updated CPT codes and Medicare fees
• 1/5/12 - Annual review and revision of compliance
• 2/10/12 - Biller/coder/physician education session conducted
• 4/15/12 - Conducted internal audit

3. File all important documentation in the relevant sections of your compliance plan. For example, file the appropriate documents under the "Education and Training" section anytime you complete an in-house training or education session, or anytime an employee attends an off-site education function. Recording what you did in the front of your manual is great -- having evidence to back it up is a must.

4. Assess your plan's effectiveness annually. Most compliance programs plans state that you need to measure the benefits of the plan every year. Try to measure where you were last year compared to where you are this year for revenue and physician-billing compliance to determine whether the plan is working.

Best practice: Make changes and updates to your compliance plan as they happen during the year. Reserve your annual review as an opportunity for reflection on accomplishments and what areas need improvement.

5. Prove your worth to physicians with data that show your compliance plan works. If you've implemented and followed through on the policies set out in your program, chances are you'll have the numbers to prove it. Show the physicians any mistakes that you caught during self-audits and train them on how to avoid making the same ones in the future.