Practice Management Alert

Hint: Write your policies with simplicity in mind so that everyone understands.

Two main goals for any compliance program include maintaining compliance and surviving a potential audit. So it’s in your practice’s best interest to make the investments in time, money, and other resources now to put a compliance program in place — or to revamp what you’ve already established — that achieves those goals.

“Maintaining compliance requires an ‘all hands on deck’ attitude, and a written plan that details exactly how staff will promote accuracy and ethical processes,” says Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California. With COVID-19 funding relief programs, blanket waivers, and other public health emergency (PHE) measures in place now, you should expect an onslaught of audits in the near future, she says. Achieving compliance may be especially tough right now as employees are feeling burned out personally and professionally, and may not be performing at their best.

Discover Some Background

While some aspects of compliance programs were once voluntary, the concept is hardly new. A 2000 Federal Register notice by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) describes a compliance program as preventive medicine. “Physicians should view compliance programs as analogous to practicing preventive medicine for their practice. Practices that embrace the active application of compliance principles in their practice culture and put efforts towards compliance on a continued basis can help to prevent problems from occurring in the future,” the notice says.

With the Affordable Care Act, practices that see patients who are Medicare or Medicaid beneficiaries are required to have written compliance plans, Fletcher notes — not just something that is “in the works” or general best practices.

Incorporate These Components

You can see what OIG and the Department of Justice (DOJ) are prioritizing, in terms of enforcement and fraud, by looking at recent criminal enforcement actions, which you can find here: https://oig.hhs.gov/fraud/enforcement/criminal. Conflict of interest relationships are a big focus lately, so keep your disclosure questionnaires up to date.

Specifically mention pertinent laws and regulations. A government audit would look at whether you address specific laws or specific behaviors with your staff or ancillary agents, says Beverly Smith, JD, CSSMBB, CPCO, in an AAPC 2020 Virtual HEALTHCON session “Guidelines on How to Demonstrate a Compliance Plans Effectiveness.”

To survive a government agency audit, the easiest way is to describe a scenario and then point out: “This is a violation of HIPAA, this is a violation of HITEC, this is a violation of Stark Law,” Smith says.

Top tip: Writing about the policies specifically is also a good way to make sure you remember to update them when necessary, Smith said. For example, if Stark Law undergoes any changes after the public comment time, then you’ll know exactly which parts of your policies and procedures you’ll need to update accordingly.

Make sure you incorporate staff continuing education — including for physicians and other clinicians — into your compliance program, Fletcher says. You want to make sure there is at least one annual compliance training, as well as training focused on promoting increased billing and coding accuracy, she recommends.

Look at the language you’re using, too. Smith says that many plans incorporate too much legalese or industry-specific jargon, but compliance programs and plans are usually presented to staff who are onboarding and may not know the acronyms your organization uses regularly or even the definition of some industry-specific words. Write the policies simply enough so the least knowledgeable person in the room can walk away with an understanding of the rules without having to ask any clarifying questions, she recommends.