Updated: Jun 17
Compliance Program Requirements Under the Affordable Care Act of 2010
Many practitioners, suppliers, and providers are unaware that the Patient Protection and Affordable Care Act of 2010 (ACA) mandates that all health care entities and providers treating Medicare, Medicare Advantage, Medicaid and CHIP patients, including individual and small-group physician practices, durable medical equipment (DME) suppliers, home health agencies, and long term care facilities/skilled nursing facilities, rehab centers/clinics, and hospitals implement effective compliance programs to prevent, detect and correct violations of federal health care laws and regulations included in the following Federal Fraud and Abuse Laws.
The Office of Inspector General (OIG) of the Department of Health and Human Services is continuing in its efforts to promote compliance programs for the health care industry. The purpose is to develop and implement internal controls and procedures that promote adherence to applicable statutes, regulations, and requirements of the federal health care programs and, as necessary, refining existing compliance programs to adopt to changes in laws and necessary corrective actions based on results and findings within your compliance plan. Below are the key requirements that OIG has called attention to.
OIG Requirements for a Compliance Program
1. Compliance Officer, Compliance Committee, Governing Body
-42 CFR $422.503(b)(4)(vi)(A); 42 CFR $423.504(b)(4)(vi)(A)
2. Effective Training and Education
-42 CFR $422.503(b)(4)(vi)(C); 42 CFR $423.504(b)(4)(vi)(C)
3.- Effective Lines of Communication
-42 CFR $422.503(b)(4)(vi)(D); 42 CFR $423.504(b)(4)(vi)(D)
4. Effective Systems for Routine Monitoring, Auditing and Identification of Compliance Risks
-42 CFR $422.503(b)(4)(vi)(F); 42 CFR $423.504(b)(4)(vi)(F)
5. Procedures and Systems for Promptly Responding to Compliance Issues
-42 CFR $422.503(b)(4)(vi)(G); 42 CFR $423.504(b)(4)(vi)(G)
Boost offers monthly and quarterly compliance plans that will:
* Assess your current compliance and privacy programs and identify areas of non-compliance.
* Create and/or manage your corrective actions to eliminate areas of non-compliance
* Manage your compliance and/or privacy programs including communication channels, investigations, reporting, root cause analysis, and corrective actions
* Manage your business associate and non-disclosure agreements
* Manage your documentation authorization requests
* Conduct compliance reviews of billed claims to identify areas of non-compliance, and conduct outreach services for medical documentation if desired
* Assess SOP’s and management of SOP reviews
* Conduct OIG background checks for all employees
* Assess your compliance with TCPA and Medicare beneficiary contact and shipment rules
* Conduct new hire training, remedial training, and annual training
* Create and/or review employee disciplinary processes and forms
* Create your Code of Conduct
In addition to letting everyone know, and the peace of mind that it brings, the biggest benefit is Boost Advisory Group can do it for substantially less than you can. Here’s why.
1. You only pay for what you want and need. Everything is customized to your needs and budget
2. You are only paying for productive hours. Hours which Boost is actually working on your compliance and privacy programs.
a. No Paying for:
i. Vacation and break hours
ii. Personal days and sick days
iii. Meetings & smoking breaks
v. Payroll Taxes
vi. Access fees, software fees, workstations, overhead
vii. Surfing the internet, personal emails, personal text messages
3. You will have highly respected professionals supporting you; Both clinical experts and industry experts.
5. If any claim that is reviewed and approved by Boost Advisory Group is denied or fails an initial audit, Boost will appeal that DOS for FREE. We provide a 100% guarantee!
We truly hope that you learned a lot and now it is 100% your decision to decide if you want to play with fire and chance your compliance, go at it alone, or call us for a FREE consultation and proposal of what Boost Advisory Group can do for you. Or feel free to contact us at 888-304-2480!