Can an Effective Healthcare Compliance Program Prevent Healthcare Fraud and Reduce Healthcare Costs?

If you realize that you need a healthcare compliance program, but feel apprehensive about what seems to be such a daunting task, this Guide will assist you in gaining the confidence that you need to proceed step-by-step in creating a healthcare compliance program that will make you proud to be a healthcare provider once again. This Guide will show you the most important elements to consider in the development of a compliance program, irrespective of the size of your practice.

It is dangerous to assume that because your practice is small (e.g., 1 doctor and 1-2
staff members), that you do not need to have such a program. Any healthcare practice can become the target of a fraud investigation!

The following steps, if followed closely, will get you well on your way to a bona fide compliance program:

Practice Analysis: First, and foremost, it will be necessary to assess the areas of your practice that pose the greatest liabilities. To determine this, you will need to consider the following:

1. Do you provide healthcare to patients who are either employees of the Federal Government who will be filing claims against/with their employers’ carrier, or who will be filing claims under a government contract (e.g., Medicare/ Medicaid)?
2. Do you accept Letters of Protection on 3rd-party liability claims?
3. Do you have high employee turnover?
4. Do you file your billing electronically?
5. Do you out-source your collections?
6. Do you contract with independent practitioners?
7. Do you contract with outside vendors?
8. Have any of your providers been sued for malpractice?
9. What percentage of your billings are denied/reduced?
10. Do you have a mechanism for responding to either denials or reductions in reimbursement?
11. Do you provide ongoing training to billing and collections employees regarding CPT coding and ICD-9 coding?
12. Do you perform background investigations on all employees prior to hire?
13. Do you provide a mechanism for reporting complaints for internal resolution?

Once this assessment is competed, it will be necessary to develop policies and procedures to allow management of each potential liability. The Compliance Manual that we have created addresses those areas that pose the greatest liabilities for the largest number of providers. It is inadvisable to merely implement these policies prior to performing a thorough analysis of your individual practice needs.

For more tips on developing your Healthcare Compliance program to prevent healthcare fraud and reduce healthcare costs, visit us at:
http://HealthCareComplianceTraining.net/