Compliance Plan Tips...don't wait!

With the passing of the Patient Protection and Affordable Care Act (ACA) by congress in March 2010, the ACA has mandated that physician practices, both large and small, implement and maintain a compliance plan effective January 1, 2014.

While it still may be a ways away, physician practices are already seeking help in creating and implementing these compliance plans every day.  Why, you may ask? Because these compliance plans are directly utilized to offset the financial impact of governmental and private payer “overpayment audits.”  These audits can result in requests for  significant sums of money back from medical providers (These overpayment requests start at $500,000 or higher depending on the circumstance).

How does a compliance plan get created and implemented? First you must identify any and all “exposures” to non-compliance a practice may have.  A “risk” review of the practice’s business processes, medical coding, and documentation identifies any exposures.   A customized policy and procedure manual is then created to document and assist in implementing any and all changes needed to the practice’s key business processes previously identified.   Finally, training should be provided for physicians, clinical staff and business staff members with a monitoring/re-training every six months.

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