Implement compliance program, wait on HIPAA

Issue: July 2002

ByCharles B. Brownlow, OD

The past 2 years have brought forth some significant federal rules and laws that will directly affect the way you deliver health care. The Office of the Inspector General (OIG) created the Compliance Program for Individual and Small Group Practices, and Congress created the Health Information Privacy and Accessibility Act (HIPAA). The compliance rules are already in effect, and HIPAA will mandate programs in every health care office some time in the next year or two.

Consulting groups and health care attorneys are already hard at work developing programs to help you comply with HIPAA. I think it’s safe to guess that insurance companies, HMOs, hospitals, clinics and small practices have already spent millions of dollars developing forms and policies based upon the language of HIPAA.

My advice is to be sure your office is well on its way to using the recommendations of the compliance program. Most of those are good common sense anyway and can actually enhance good patient care. The plan was created to put many of the same requirements on small practices that have been in place for hospitals and larger clinics for quite a while. Anyone who provides any services to Medicare or Medicaid patients is expected to comply with this program.

As for compliance with HIPAA, I recommend you watch and listen carefully for the next few months — at least until Rip Van Winkle, MD, DDS, DO, DPM, OD, awakes.

Protecting patient privacy

HIPAA is the most far-reaching federal program in history for health care offices. It mandates that you send several forms to every patient, explaining what information you have, how you intend to use it and with whom you intend to share it. It mandates that you keep secrets secret and that you keep in-office communication quiet, protecting patients’ privacy with respect to their health information and the related financial information.

This bill passed Congress in spite of resistance from many providers, insurers and their respective professional organizations. Many saw the tremendous potential costs of the program and protested. Many saw the tremendous burden of staff and doctor time devoted to compliance and protested. Yet the bill passed.

I predict that the act will not be implemented as it is currently written. Already, Pres. Bush has given in to pressure from the providers and has agreed that some of the requirements should be relaxed. I say there will be more such softening.

The first deadline for compliance with HIPAA was October 2002. That has already been moved back to April 2003, and I predict it will be delayed even more than that. The grassroots doctors of medicine have not yet been heard from, and until they are it is impossible to predict how sweeping the changes in this act will be or how long its implementation will be delayed.

Preparing for compliance

In the meantime, here are my recommendations for what you should be doing to prepare for these two programs. Put the medical records compliance program into action in your office, as directed by the OIG. If you have already implemented it, take a close look at it and refine it. This program should include a system of monitoring and auditing claims submission practices within your office to be sure each claim reflects the service provided and the record of that service.

Adopt standards for your office with respect to medical record keeping and claims submission. These should include proper coding and billing, making sure all services are reasonable and necessary, making sure all care is properly documented and making sure all relationships with other providers and suppliers are free from any improprieties, such as kickbacks, self-referrals or improper inducements.

Assign a doctor or staff person to act as the compliance officer for your practice. This person will read all information about compliance and will help others in the practice follow the rules. This person may be an outside consultant or an owner or employee of the practice.

Develop a program of training/education for all doctors and staff to be sure that everyone understands the rules for medical record keeping and claims submission. The program would first identify who needs the training and what type of training is needed and then schedule training specifically for those who need it.

The compliance plan should provide for detecting any violations of accepted standards for medical records and claims submission and provide a plan for correcting those violations.

The compliance plan should make it very clear that all staff are welcome to comment on any apparent violations of standards and are encouraged to report those deviations to the compliance officer for the practice. Staff members need to understand that compliance is more important than damaged pride or hurt feelings with respect to record keeping and claims submission.

The office should try very hard to apply the rules uniformly among doctors and staff members to be sure that all are making their best efforts toward appropriateness of the care provided and accuracy of record keeping and claims submission.

Preparing for HIPAA

Learn all you can about HIPAA and encourage your practice’s doctors and staff members to do the same. Use each staff meeting to compare notes and learn from each other about any expected requirements with HIPAA, implementation deadlines, modifications in the original requirements and sample forms to be used in the program. Sources for such information include:

journals and publications, such as Primary Care Optometry News;
information from professional associations and other groups, via newsletters and journals;
Web sites;
information from the federal government via direct mailings to providers and postings on key Web sites for the agencies;
information from the lay press. Often, the nation’s newspapers will be the first to alert you of general news related to HIPAA and its potential impact on your practice.

Legislators will respond to constituent/health care provider pressure and may suggest changes. Pres. Bush will continue to be pressured by providers and insurers to soften the impact of HIPAA. Patients will object to the increased cost of health care resulting from compliance with the privacy requirements and will pressure Congress and the President.

For Your Information:

Charles B. Brownlow, OD, FAAO, is executive vice president of the Wisconsin Optometric Association and vice president of operations of Practice Management Inc. He may be contacted at Practice Management Inc., 5721 Odana Rd., Ste. 102, Madison, WI 53719; (800) 827-1945; (608) 274-5044; fax: (800) 308-7189; (608) 274-2674; e-mail: brownlowod@aol.com.