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Make a new year's resolution to tune up your compliance plan
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The start of a new year is a great time to consider your compliance plan. If you don’t have one, then it is time to fix that. If you do have one, then consider a few easy things you can do to improve your odds of faring well in the event of an audit.
Compliance plans were born out of the federal sentencing guidelines. If a corporation is convicted of a crime, then the presence of a compliance plan can lower the company’s penalties. But the real reasons to adopt a compliance plan are not based on the sentencing guidelines. They are more practical. First, a good compliance plan may avoid billing errors. Second, if you do make an error, then a good plan may convince the government that any error is inadvertent.
Simple steps
A very simple step is to ask every employee in your organization to sign a certification either 1) disclosing all compliance concerns the person has or 2) attesting that they have no compliance concerns. If you would like a copy of a sample certification you can use, please email me at dglaser@fredlaw.com. This form should be used at least once a year, but using it semi-annually may be better.
Often, the majority of the “issues” uncovered when you ask about compliance are human resource issues (i.e., “Jonny talks on the phone rather than working.”). But if you do find a possible compliance issues, then you need to determine whether the concern is legitimate. Don’t be too quick to dismiss an allegation. In one case, a patient complained that she was billed for a physical but never removed any clothes. A review of the medical record revealed a complete physical. It would have been easy to dismiss the patient as a crackpot. But further investigation revealed that the physician was using template exams that were regularly recording data that wasn’t performed. Only a cynical administrator was able to discover the problem, thus allowing the clinic to handle internally a potentially explosive situation.
Government agents
You should also use this as a chance to remind your staff how to respond to if they are contacted by a government agent. If you would like to provide staff with “what you need to know if you are contacted by a government agent” cards, then send me an email. We provide them free of charge. Staff should know that while they have the right to talk to a government agent if they are contacted, they are also free to choose not to speak with the government agent. They should understand they have the absolute right to tell you if they are contacted by an agent, even if the agent indicates that they would “prefer” that they don’t. Employees also should know that the clinic will pay for a lawyer to attend any interview with a government agent. Providing this education on a regular basis is one of the best risk management tools available.
Finally, during the course of the year, either you or your administrator should have regular conversations with your coders and billers. Ask how things are going. Ask whether there is anything they are worried about. Explore whether they have any concerns about compliance. Taking the time to have a close relationship with coders and billers is time well spent. Have a high-level person in the clinic make this a priority.
Compliance plans may not be all that exciting. But like a good vaccine, they can keep you in better shape.
Finally, if you are going to be at Orthopedics Today Hawaii 2013 and you are a regular or even periodic reader of this blog, then please come up and say hello. Hope to see you in Hawaii. Happy New Year!