The need for an effective compliance program for healthcare organizations transitioned from voluntary to mandatory with the requirement in the Patient Protection and Affordable Care Act (PPACA) that healthcare providers applying to enroll as Medicare providers have a compliance program in place. The Fox Group, with its team of healthcare compliance experts, is well-equipped to help your organization to meet these provider obligations. Our grasp of the regulations that govern HIPAA and other healthcare compliance requirements is uniquely blended with real-world practical experience from our staff’s years of working in direct provider operations.
One of the keys to a compliance program is to make it truly effective, and we can help you to do that. It must be more than a document initially adopted by the governing body and reviewed once per year. The Office of Inspector General (OIG) of the federal Department of Health and Human Services (HHS) recommends specifics about the components of a compliance program.
Healthcare compliance program & HIPAA requirements:
- Developing and implementing compliance program policies and procedures
- Designating a compliance officer or contact person
- Conducting appropriate training and education of staff
- Responding appropriately to detected offenses and developing corrective action
- Developing open lines of communication, and
- Enforcing disciplinary standards through well-publicized guidelines.
The Fox Group recommends that some additional areas (listed below) be addressed in a healthcare compliance plan because their integration will shore up an organization’s ability to best integrate the federal requirements in a more systemic manner that will make adherence to required areas more manageable.
Compliance program policies and procedures should cover areas such as:
- Hiring practices
- Healthcare insurance and billing compliance
- Medical records releases and informed consents
- Professional courtesy discounts for services
- Diagnosis and procedure coding for medical services
- Medical necessity and documentation
- Business and medical records retention
- Confidentiality
- Patient rights
- Employee safety, rights and obligations, and
- Environmental concerns
Each healthcare organization also needs a Code of Ethical Conduct, setting forth the expectations for all staff members for ethical conduct within the organization.