Compliance Plans

It is foolish to think that HIPAA is all there is to Compliance!
If an Inspector from the Office of Inspector General (OIG) visited your practice today, would they see some tell-tale signs of non-compliance?

  1. Computer screens and patient records in plain sight. This is a big red flag! It could mean your office is lacking in confidentiality and security policies.

  2. Coding books are outdated. Coders not using current books or software are a compliance risk to your practice. Using outdated codes will cause unnecessary denials and appeals.

  3. Memos or “cheat sheets” posted for coders. It’s acceptable to use a “cheat sheet” if you are a specialty and want to keep the most frequently utilized category at your fingertips. An Investigator might see this as a problem if “cheat sheets” only list the higher paying Evaluation & Management or procedure codes. Lists should include all codes, not just the highest reimbursement. Remember, it is not appropriate for the coder to change a diagnosis code just because it is the only one that will get paid for certain procedures. The medical policies (LMRPs) are reference tools only.

  4. Compliance Contact not posted. Designate someone or a committee to address compliance problems within the practice. Confidential employee and/or patient complaints with follow-up and resolution will prevent legal problems.

  5. A Compliance Manual sitting on a shelf collecting dust. This manual should be a reference tool and updated regularly as policies and procedures change.

Medical practices can avoid significant civil and criminal monetary penalties by utilizing a Consultant to review and establish compliance policies and procedures.

  • Our Specialist will develop and write internal medical practice Compliance Plan
  • Implementation of Plan with Management, Staff, and Physicians
  • Ongoing regularly scheduled meetings with Management and Staff for internal auditing and monitoring processes

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