Going Up

Welcome back to Compliance University. Class is now is session! “Rule Overload” is reaching crisis proportions. Home medical equipment suppliers are “at the end of their ropes” from the stress of trying to keep track of and comply with the rules that govern the industry.

The ROPE (Rule Overload Prevention and Elimination) System is a solution to Rule Overload that is premised on this common-sense idea: You need to run your company in a manner that achieves all of your goals, not just “obeying the rules.”

We’ll use the metaphor of a “ROPE Ladder” with five rungs for this climb to success. These five rungs help you create effective operating systems for your company that facilitate your goals in general. In other words, the ROPE System can be a blueprint for running your company’s systems the way you want them to run, for all of the reasons you value.

Let’s start climbing our ROPE Ladder!

ROPE Ladder Rung I: Determine how you intend things to run. You need three strands to weave this rung into your ROPE Ladder:

• Strand 1: Acknowledge your reality. Acknowledge your Utopia. Identify how you wish to run each of your operating systems — patient relations, vendor relations, billing and collections, medical records, warehousing and delivery, installation and set-up, sales and marketing, etc. First, analyze objectively how you currently run these systems. Even if these systems are not part of separate “departments,” you run each of them with their own set of internal rules. Second, identify how you want to improve these systems.
• Strand 2: Apply “rules” as necessary. Determine if any of the rules require you to modify your operating procedures. You may need to hire advisers who offer both knowledge and practical advice. You may also need to read the compliance literature, attend educational programs or review your payer contracts. This job can be delegated to your compliance staff, but you should draw on your department heads for particular expertise. For example, your director of reimbursement will likely know the most current policy directives from your DMERCs.
• Strand 3: Write it down. This drafting project is crucial and should be handled by your compliance team as well as by representatives from the affected departments. Edit each draft policy carefully, verifying that each reflects your intended “best practice,” that your intent is practical and that the policy can be understood by someone who did not draft the policy. Finally, your compliance team should double-check that the policy conforms with “the rules.”

At this point, you will have determined the best practices for each particular operating system you have analyzed. They are a combination of present-day reality, improvements you would like to make and refinements required by the rules. Note that this process is very similar to the “Gap Analysis” you may have used to prepare for HIPAA.

Time’s up for now! Next time we’ll discuss in detail these three strands in Rung I, as we climb our ROPE Ladder to compliance success. Class dismissed!

Neil Caesar is president of the Health Law Center (Neil B. Caesar Law Associates, PA), a national health law practice in Greenville, S.C. (www.healthlawcenter.com). He also is a principal with Caesar Cohen Ltd., which offers compliance training, outsourcing and consulting. A frequent author and speaker, Caesar is the author and editor-in-chief of the Home Care Compliance Answer Book. He can be reached by e-mail at [email protected] or by telephone at 864/676-9075.

The ROPE Ladder

Rung 1: Articulate the way you want things to run, and note how they run now. Then, tweak your systems as necessary to comply with “the Rules.”

Rung 2: Teach your operating systems to your employees.

Rung 3: Implement a clear and simple method for dealing with problems — identify them, report them, investigate them and fix them.

Rung 4: Give your compliance staff resources to help them keep up-to-date with internal and external changes that may sometimes require you to refine your operating systems.

Rung 5: Monitor your operating systems to make sure they continue to run as you intended.