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Don't Play with Fire...

Updated: Jun 10

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.


Benefits of a Compliance Plan

The benefits of a compliance plan are numerous. We attempt to call out the largest ones, but understand, that they are many more:

1. Proof to regulatory agencies that you are committed to running a clean and compliant business that strives to do the right thing.

2. Compliance with the Affordable Care Act of 2010

3. Potentially reduced fees and penalties when facing regulatory issues

4. Less potential ADR, TPE, RAC, CERT, and UPIC audits because your routine monitoring policy is identifying and correcting issues before an audit occurs

5. Higher win rates and less time spent on audits because your business is compliant and prepared for the audit

6. Reduced Legal fees

7. Improved bill rates, collection rates and cashflow due to compliant claims

8. Decreased labor expenses by avoiding to take a reactive clean up approach after receiving the audit(s) request

9. Reduced unbilled revenue and AR aging

10.A better trained, compliant, and effective staff

The Costs of Non-Compliance:

Negative impacts of non-compliance to business owners are as follows:

1. Criminal Prosecution

2. Civil Prosecution

3. Revocation of NPI and Billing Privileges

4. Six Month Payment Suspensions

5. Extrapolations With Look Back Periods of 36 Months

6. Recoupments

7. Denials and Audits Leading to Elevated Unbilled Revenue & Decreased Cashflow


What are the typical costs of compliance and privacy?


Compliance can be costly, albeit, no where near as costly as non-compliance. Here are some national averages of salaries for the typical roles that an organization would hire for internal positions.

Compliance Officer: $77,400

Compliance Specialist: $59,794

Privacy Officer: $77,995

Privacy Specialist: $55,597

Medical Records Auditor: $58,363

And keep in mind that any internal position means you are paying for non-productive hours (studies suggest up to 40% of the total time paid), in addition to, the following expenses:

1. Payroll Taxes

2. Benefits

3. Software Fees Per user

4. Workstations

5. SG&A


If you are like most, none of the above feels highly appealing. That is why Boost Advisory Group has created a customizable option that provides a highly beneficial approach to being compliant and profitable.

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

iv. Benefits

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.

4. You qualify for 5-10% off all other Boost Advisory Group Services; no need to pay for expensive legal fees

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.

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Boost Advisory Group are experts in DME consulting, DME revenue optimization, Brightree consulting and optimization, DME business process outsourcing, Medicare TPE, RAC, and UPIC audit response services, executive coaching, operational development, Analytics and reporting optimization to improve topline and bottom line. We are experts in helping our clients grow their business by reaching operational and financial excellence.

Boost Advisory Group is an independent company that is not associated, or affiliated, with Brightree ® or any software provider and therefore our clients can leverage our deep industry knowledge without bias, so they can receive a fair and objective advantage.

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