Episode 33: You NEED a Compliance Plan

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May 04, 2021

Everyone knows that there are lots of  rules and regulations in healthcare. In order to help you complying with all of the complicated healthcare laws,  I'm going to tell you why you need a compliance plan and what it needs to include.

Before I get started, I want to get one common misconception out of the way. A lot of people think that you only need to have a compliance plan if you participate in government insurance plans.  The truth--every practice needs a compliance plan. 

Why? 
A formal compliance program is an indispensible part of an overall risk management plan for your medical practice. 

Compliance programs address billing practices, anti- kickback compliance, state and federal self-referral prohibitions, state fee-splitting laws, licensure and accreditation requirements, labor relations matters, antitrust and price fixing prohibitions, HIPAA and medical records issues and a whole host of other state and federal laws. 

The very first thing you need to do is select a compliance officer.

What goes into a compliance plan?

  • Standards of conduct for your employees 
  • Determining what is medically necessary 
  • Compliance plan for billing--regardless of whether you take government and third party payor or only cash
  • Compliance plan for how you market

Now that you know what needs to be included, how do you come up with the compliance plan?

  • You have to have written guidelines and manuals 
  • You need to train your employees 

What happens if there is non-compliance?

  • You have to have a plan to address non-compliance is handled that defines how issues are reported and evaluated. And, of course, every aspect of the investigation requires a paper trail. 

And one of the most important parts of a complete compliance plan is the audit. You can demonstrate your compliance by being proactive and auditing yourself. This goes a long way if you are ever involved in an investigation. 

In the end, being compliant really is nothing more than having a tangible, systematic plan for doing the right thing.

For a full searchable copy of the transcript, click here

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