Compliance training does not require the same education for all personnel. Handing employees the anti-kickback or HIPAA regulations accompanied by a big memo warning them to read and heed or face reprimand is neither necessary nor desirable. Lazy managers who lead by memo might take this route, but leaders building an effective company will take the time to train — and retrain — staff about the internal policies and procedures that matter to their individual job responsibilities. Obviously, your compliance team should possess dog-eared, tape-flagged, highlighted copies of useful HIPAA, reimbursement and anti-fraud resource materials and should keep trusted consultant phone numbers handy. However, the receptionist answering the phone, the delivery scheduler or the records manager need only be familiar with a few policies that...

Some health care companies treat “the rules” like viruses that spread panic and confusion within organizations. This seemingly infectious bug — the “compliance panic virus” — causes a dreaded disease: Rule Overload. But there is a vaccine for this disease. One key prescription is training, but not specific training in HIPAA rules or anti-fraud rules or Medicare reimbursement rules. Rather, the cure is to teach your personnel how your day-to-day operational policies and procedures already address these rules. The “rules” require you to have compliant policies and procedures, but they do not require that you teach or learn the hundreds of pages of regulatory rules. Instead, teach your staff how to follow your company’s policies and procedures, how these policies and procedures deal with the...

The ROPE (Rule Overload Prevention and Elimination) system reduces “rule overload” while improving profitability and operational efficiency. Complying with the system requires climbing a ROPE ladder with five rungs. The first rung consists of three strands woven together: (1) Articulate how you want your systems to run and note, dispassionately, how they in fact do run; (2) identify whether the way you want to do things needs to be modified to satisfy legal rules; (3) and, finally, write down the operating policy. A Draft Policy But does this first rung really work? To find out, try running a preliminary test by creating a draft equipment purchasing policy. Start with questions. How do you purchase equipment? Do you have a standing order for minimum inventory? Do...

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...

Welcome back to Compliance University. Class is now in session! Let’s explore solutions to the problem of “Rule Overload,” which we defined last time. Rule Overload afflicts the majority of health care providers who approach compliance from a “learning the rules” perspective. Instead of keeping track of all the rules, the ROPE System is a new method for achieving Rule Overload Prevention and Elimination that incorporates rule-compliant behavior into your existing operational systems — billing, warehousing and maintenance, delivery and set-up, medical records, contracting and marketing, and so forth. This is a new way to view compliance. Forget the “rules.” Just make sure your own systems run as you intend them to run! So, how can you subsume the concept of “compliance” into your own...

Welcome back to Compliance University — Class is now is session! This month I will begin a “maxi-series” of articles to address a major problem home care providers face: Rule Overload. Let’s listen to the home care providers’ lament: “Help! We must track hundreds of reimbursement rules, OSHA rules, CLIA rules, anti-fraud rules, privacy rules, security rules, government rules and private payer rules! It’s too much to monitor, let alone conquer. We’re at the end of our rope!” Clearly, these providers suffer from that new malady “Rule Overload.” Perhaps HIPAA has elevated the rule-overload problem to epidemic proportions by imposing specific and detailed regulatory obligations with firm deadlines for compliance. While it is true that new reimbursement rules also have firm deadlines for enforcement, the...

Welcome back to Compliance University! Since our last session, the Health Insurance Portability and Accountability Act’s privacy provisions have taken effect, and most of you have the necessary policies in place. Some of you (the wiser ones, in my opinion) are beginning to realize that it is not enough to know “the rules.” But if HIPAA compliance is not about the rules and the policies, what is it about? The secret is to create a system to manage compliant procedures. Then, run the system, don’t run the rules. Teach the procedures, don’t teach the law. Monitor the activity, don’t monitor the words. At its core, an effective compliance program is a “systems management” program with a few key elements. To create the system, you should:...