A compliance plan is a formal documentation of a healthcare practice’s checks and balances system. This is regarding the business’ general operations, government-mandated regulations, and services provided to patients. All healthcare providers in the United States are mandated to have this plan in practice.
It serves as the guide for a practice’s compliance program and ensures that its staff conducts themselves ethically to reach their goals. In addition, it encourages the practice’s employees to report behavior that is not in line with the established program.
The Patient Protection and Affordable Care Act require all practices to implement a formal compliance program to prevent fraud, waste, and abuse. It is also a prerequisite condition for all healthcare providers before enrolling in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
Why Is It Important to Have a Compliance Plan?
Apart from being required by the law, having a compliance plan is a matter of establishing your practice’s ethical standards. It helps your practice put its integrity as a service provider above all else. In addition, it outlines your protocol for when there are unethical methods being implemented. It is an important measure that can also solidify your patients’ trust in your practice.
Having a compliance plan is vital for organized internal crisis management. In the unlikely event that an employee carries out activities unbecoming of someone in your team, you have a defined protocol for investigation and sanctions. Your employees are also provided a clear set of instructions on how they can report such incidents to their supervisors.
A compliance plan is essential for your practice as it outlines the ethical standards of your service and the protocol for addressing abuse by your team. It also keeps your practice in line with the country’s healthcare sector laws. In addition, having a compliance plan opens up opportunities for you to enroll in various government healthcare programs.
What You Should Consider When Making a Compliance Plan
For a compliance plan to be effective, there are seven essential elements that must be included. These are determined by guidelines from the Office of Inspector General (OIG).
Compliance Officer or Leader
For a compliance program to be successful, a leader or officer must be at its helm. They must take charge of the implementation and any changes that must be made under the plan. In addition, they must be properly trained by the practice owner or owners and be allocated with a budget to help them perform their function correctly.
For a compliance officer to be effective, they must be dedicated solely to the role. If you have a sizeable practice, it is worth your time to establish a compliance department to help merge all efforts related to your program. This also makes it easier for your practice to be monitored for compliance.
Guidelines for Practice Standards and Policies
It is the responsibility of all healthcare providers to provide a system of check and balances. This starts with establishing the standards that the practice must meet and uphold at all times. Your standards must be realistic, timely, and specific to ensure that your practice can follow them to the letter.
Once your standards are defined, your policies must follow suit. They must be in line with your goals and clear enough so your employees can follow them with minimal supervision. Policies must also be measurable so you can determine their effectiveness in ensuring that your employees meet the standards.
Medium for Policy Communication
A comprehensive plan is still useless if your employees are not informed about it, especially when there are policy changes. When your practice is inspected for your “culture of compliance,” your employees must be capable of explaining the compliance plan and accompanying efforts.
Effective communication is vital to ensure that everyone is onboard and updated with the practice’s policies. Direct communication channels also make it easier for your employees to report concerns regarding the policies. This can include potential compliance issues with fellow employees and protocol checking for complex patient-related situations.
Employee Compliance Training
Training is crucial to ensuring that your compliance plan will be implemented properly in your practice. Everyone, regardless of position or responsibility, must undergo education and guidance on the company’s protocols. This must be spearheaded by the compliance officer and properly documented for audit purposes.
Training is also required upon hire, with follow-up sessions each year. Topics that must be covered include:
- Patient and employee documentation requirements
- Health and safety protocols
- Medical information security as mandated by the HIPAA
- Compliance plan specifications
- Charges and billing procedures
For the sake of your practice’s integrity, any abuse, waste, or fraud as well as failure to report any incident of abuse or fraud should not be tolerated. Disciplinary actions must be clearly defined in your compliance plan for these types of incidents. It is also critical that employees know that termination of their employment can be implemented depending on the severity of their infraction.
Process of Investigation for Employee Compliance Issues
Any potential compliance issues should be thoroughly investigated. The process undertaken should be transparent to all employees beforehand to promote fairness and help avoid any discrepancies. Develop an action plan afterward and monitor the results to determine the plan’s effectiveness.
Ensuring that your practice is complying with the set standards is done through periodic auditing and compliance monitoring. This helps you spot which procedures are working and which ones need more polishing. A proper audit should also include the level of your employees’ compliance. Additional training may be necessary for those who are not meeting standards.
Develop a Compliance Program With Practice Management Consultants in Worcester, MA
To ensure that your compliance plan is well-constructed and covers all aspects of your practice, contact New England Accounts Receivable Management today. We represent more than 150 clinicians and more than 50 healthcare providers in the New England region. Our expert consultants will help you assess your compliance program needs and educate you on mitigating compliance issues as well as financial risks.
We aim to help you boost profitability and enhance efficiency at your practice. In addition, we can work with you to ensure your practice operates in compliance of the guidelines of the Office of the Inspector General. Contact us today so we can discuss your organization’s requirements and how we can help you.