Transcript
Organizational Governance
ACTION PLAN Practice improvement strategies
7 elements of an effective corporate compliance program
C
orporate compliance is not a new concept in medical practices. Since 2000, the Office of Inspector General (OIG) for the US Department of Health and Human Services has outlined medical practice compliance with federal, state and local laws for billing and operational practices. The instructions were published in “Compliance Program Guidance for Individual and Small Group Physician Practices” In the Federal Register.1 However, there’s still a lot of uncertainty on the depth, breadth and scope of work needed to maintain an effective compliance program. While such programs are not difficult to implement, it is critical to focus on measures of success and effective ways to demonstrate and document implementation of the following elements of compliance programs: 1. Compliance committee composition evaluation. Ensure the committee has a written charter that articulates its focus. (See the sidebar about Huron Hospital and Huron Medical Group’s corporate compliance program on page 22.) The committee should meet at least quarterly to review its ability to fulfill the seven elements of a corporate compliance program and evaluate member effectiveness through evaluations. 2. I nventory. Determine what policies and procedures help you achieve your compliance goals and review them periodically to ensure they meet the intent of compliance. For example, one medical group had a policy on interaction between physicians and pharmaceutical vendors. Unfortunately,
©2012 MGMA-ACMPE. All rights reserved.
it was not well understood and as a result, it wasn’t followed. The vendor guidelines were revised and clarified to ensure that sales representatives were not permitted to meet individually with residents, fellows or medical students unless the meeting was part of an educational conference. 3. C ommunication. Ensure that regular verbal and written communication occurs. Update articles in employee newsletters, send monthly e-mails with compliance topics, add compliance agenda items to department meetings and make presentations at leadership and board of directors meetings. Consider rotating topics, such as HIPAA, security, privacy, confidentiality, research, billing/coding, codes of conduct, information technology, quality/safety, and fraud and abuse. Communication in different venues throughout the year helps reinforce the importance of compliance and reminds staff to maintain compliance practices. Engaging staff in compliance efforts creates a critical, two-way communication. 4. T raining and education. The committee should continuously develop education that drills down to the physician and employee levels. (See training topics sidebar on page 22.) It should include information about how employees perform their jobs in compliance with practice standards, applicable regulations and the practice’s commitment to an effective compliance program. see Action Plan, page 22
By Michael O’Connell, MHA, FACMPE, MGMA-ACMPE member, vice president of clinical services, Marymount and South Pointe Hospitals, Cleveland Clinic Hospitals, Garfield Heights, Ohio,
[email protected]
mgma.com • mgma.com/policy • mgma.com/hipaa • mgma.com/bok • mgma.com/acmpe
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from page 21
ACTION PLAN
To maintain an effective compliance program, focus on measures of success and effective ways to demonstrate and document implementation of these seven compliance program elements.
Sample corporate compliance charter Huron Hospital, a Cleveland Clinic hospital, and Huron Medical Group are committed to their corporate compliance program in collaboration with Cleveland Clinic. It is our goal to work with our employees, physicians, volunteers and business associates to ensure that they conduct activities in full compliance with applicable federal, state and local laws, regulations, policies and ethical standards. The program is developed to be part of routine hospital and medical practice operations and integrated into the Huron Hospital and Medical Group culture. By acting in fulfillment of the program, Huron Hospital and Huron Medical Group are able to fulfill their mission to be the best place to receive care, the best place to practice medicine and the best place to work. The Huron Hospital Corporate Compliance Committee comprises a chairperson and multidisciplinary membership from throughout the hospital. The committee meets periodically to provide education, support, resources and information about compliance initiatives.
Examples of compliance training topics • What is HIPAA and how does it apply to me? • The impact of social media on patient privacy • If it’s not documented, it wasn’t done — improving documentation in the medical practice • Learning about billing and coding requirements: Coding and billing challenges, reasonable and necessary services, improper inducements and documentation • Fraud-fighting efforts • Eight compliance trends likely to affect you • RAC audits: How could they impact me?
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The OIG has created educational materials to explain federal laws on fraud, waste and abuse, including a physician self-study booklet titled A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse with a companion PowerPoint presentation and speaker notes. (See sidebar on page 23.) This presentation can be supplemented with customized training on compliance roles for physicians and staff. 5. Documentation. Monitoring and auditing activities should be documented with the activity title, its purpose or objective, start and end dates, metrics measured and any key findings. This type of risk assessment helps a medical practice set annual goals. The OIG Work Plan (available at oig.hhs.gov/publications/ workplan/2011/) helps keep the focus on areas of OIG interest and align monitoring and auditing. Sample forms (Figure 1, which is posted online) demonstrate the importance of checklists, guide sheets and templates for audits to ensure that the audit monitors areas of risk. Compliance audits of all applicable departments and areas should be done at least annually. 6. A ction plan. Document the action plan with appropriate follow-up actions, including the project end
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date. Maintain a log with compliance issues. Work closely with appropriate departments to investigate issues. For example, inappropriate access to a patient’s medical record would involve human resources, information technology, the group or department directly involved (such as nursing) and the compliance officer. The investigation needs to be comprehensive, and each group should document what was done to support the claim. The compliance log helps ensure a level of consistency in handling situations and identifying trends. Any deficiency should be addressed with additional education and communication about the importance of compliance. Share topics of concern, not specific cases. 7. D isciplinary action. The compliance plan or practice procedures and policies should indicate when employee retraining or disciplinary action is warranted, up to and including termination. A review may determine that the practice should report the violation to the applicable agency or authority. Some medical practices have zerotolerance policies when there is inappropriate access to patient medical records. Any access that is not related to a business purpose results in termination. In these practices, strong compliance commitments are enforced with employee orientation and on-boarding and reinforced with regular communication, training and education.
Tips from the OIG A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse Educational materials available at oig.hhs.gov/fraud/PhysicianEducation/02payers.asp. • • • • • • • • • • •
Physician Education Home Introduction Fraud & Abuse Laws I. Physician Relationships with Payers II. Physician Relationships with Fellow Providers III. Physician Relationships with Vendors Compliance Programs for Physicians Where to Go for Help What to Do If You Think You Have a Problem About the Booklet Download the Booklet
join the discussion: Share tips for corporate compliance with your colleagues at mgma.com/connexioncommunity. Notes: 1. Compliance program guidance for individual and small group physician practices. Federal Register, Notices, 2000 Oct. 5; 65(194): 59434-52. Available from: oig.hhs.gov/authorities/docs/physician.pdf.
Get a sample form online at mgma.com/virtualconnexion. Click on the current issue and then on the online exclusive tab to the left to see the form.
The compliance process is dynamic and requires engagement to ensure that groups fulfill the seven elements of an effective program. By considering these steps, medical practice professionals demonstrate their commitment to corporate compliance.
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