Time for Compliance

It’s the start of a new year, and many of us begin with a resolution. What was yours? Was it personal, did it involve business or was it both?  Well, if you are looking for ideas, please allow me to make a suggestion that will pay off in 2012.

Like all resolutions, it takes hard work, sweat and maybe some tears of frustration; but the result can make your company better and protect you in the event of an audit. What is this resolution? It is a corporate billing compliance plan. Yes, I know — it doesn’t sound like fun, and it’s a lot of work. But success comes to those who are willing to put in the time and effort.

The Office of Inspector General issued voluntary Compliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics and Supply (DMEPOS) Industry in 1999. This was a voluntary program which focused on the billing practices of DMEPOS providers. Understandably, some organizations look at it as one more costly hoop to jump through, but it is a best practice mechanism for providers to have in place.

Here are benefits of a compliance program:
1) Assists with compliance in the face of our industry’s current audit environment
2) Aids with detecting risk areas within your organization
3) Establishes training protocols which promote compliant billing techniques
4) Involves management in the process and audit techniques to ensure compliant revenue cycle management
5) Supports business decisions which are based on the pulse of the auditing bodies and reimbursement rates of the industry

Implementation of any new program is difficult, and providers should not over-analyze what is required. Keep it simple, and make it work for your company’s specific needs. The first step is gaining support and buy-in from corporate leadership. Next, choose the program champion who will head up the project and be the designated compliance officer.

Here’s one idea: When combining accreditation standards with compliance guidance, make this part of your performance improvement plan.  As new employees are hired, train them on the importance of compliance as well as working with your veteran team members. The program requires continual monitoring by the compliance officer and those designated to monitor the various aspects of the program.

Your company has many of these protocols in place; it is just a matter of putting them to paper and solidifying what you are now doing. Take it one step at a time, and stick with the basics.  Review the seven basic elements as described in the compliance guidance. Take each risk factor listed in the compliance guidance, and review how your organization now addresses those issues.

The program will take shape as each element and risk factor is addressed. Surprisingly, after the pain of putting it in written form, you will notice that your billing department employees will feel more secure with their positions and how they perform duties. Parameters which are set and monitored give team members a structure of security. Of course the rewards and security are difficult to detect at the start of the process. Short-term pain for long-term gain—isn’t that what a resolution is about? The pain of the process is worth the success at the finish line.  Make 2012 the year you take control of your revenue cycle process, and begin to feel secure about procedures. So when the audit cometh, you can face it with confidence.

HomeCare, January 2012