Two Peas in a Pod

Well, it’s official: Accreditation will be mandatory for all home medical equipment companies in September 2009.

Progressive HME providers recognize that accreditation can help them refine and validate their quality assurance risk management and utilization review activities. In other words, if you handle it correctly, accreditation is not only a means toward an end but will also help improve the way you do business.

Similarly, a carefully crafted and effectively implemented regulatory compliance system can help providers utilize their own policies and procedures to avert violations of federal and state anti-fraud and abuse rules, and to satisfy reimbursement requirements. Smart companies know that a practical and effective compliance system can encourage regulatory and operational best practices that reduce the risk of serious government challenge.

In other words, if you handle it correctly, a regulatory compliance system is not only a means toward an end but will also help improve the way you do business.

HME companies generally believe their operations are correct, proper and legal. However, very often they or their employees have done things that may violate federal or state rules or, at least, that could trigger a Medicare or Medicaid investigation. Most HME companies are unaware of the extent of their exposure. They may be ignorant of the illegal activities. Or they may engage in conduct that can be questioned and challenged, even though it is common in the industry.

A compliance system is essentially an internal communications process. Its purpose is to establish a framework for identifying “the best” operational policies; assessing compliance with those policies; identifying problems to evaluate; investigating the problems; fixing the problems; and educating and training personnel about the operational policies and the compliance program’s procedures.

There is much overlap between these compliance activities and accreditation efforts.

The process for obtaining and maintaining accreditation also requires a company to identify its operational policies; assess its compliance with those policies; identify, investigate and fix problems; and educate and train personnel. The company’s compliance system thus offers a pre-existing framework for assessment, investigation, training, problem-solving, etc. Conversely, the accreditation process identifies most of the topics to be addressed in the compliance program.

Indeed, a number of benefits that flow from an effective compliance system also correlate to accreditation benefits. Both programs, when run effectively:

• Improve internal communication;
• Encourage effective employee feedback;
• Reduce the likelihood of wrongdoing;
• Create efficient structures for disseminating information;
• Improve employee skills in dealing with ethics issues;
• Provide “self-policing” reassurance to the HME company’s board of directors, alliance partners, payers or investment community;
• Constitute an increasingly important part of due diligence for acquisitions, mergers, etc.;
• Demonstrate that the HME company “has its act together.” This is important to demonstrate value in alliances, mergers, etc. It is also useful to help obtain the “benefit of the doubt” with the government; at a minimum, it can help turn a long investigation into a short inquiry;
• Create the ability to respond quickly to problems; and
• Develop reporting mechanism for problems, to protect the HME company without evading its reporting responsibilities to the government.

When you think about it, it is not surprising that there is much overlap between compliance and accreditation efforts, both substantively and procedurally. Compliance makes accreditation easier. Accreditation makes compliance easier. Now is the time!

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