Best Practices for Better Results

Compliance

Parastar’s Position on Compliance

The entire health care industry is changing rapidly with new legislation dictating terms and procedures today more than ever. As a result of this dynamic and often confusing environment, health care professionals need to acknowledge and proactively address the federal fraud enforcement environment through the establishment of a compliance plan.

Essentially, a compliance plan is a series of policies and procedures providing guidance on how organizations and their employees should apply the new laws. They can also help to identify under-coding and improve communications within an organization. In order to make your organization more effective, a compliance plan must ensure that everyone in the organization understands the obligation to comply with established and understood standards, and that the organization will take actions to uphold those standards. 


A Clear Commitment to Compliance

Having an effective compliance plan is now essential for any organization dealing in health care. Parastar helps clients create compliance programs that truly become company assets. When properly designed and administered, they assure your organization is by providing evidence that if and when errors do occur, that those mistakes were inadvertent and not part of an organization’s normal practice or procedure.

A Picture of an Effective Compliance Plan

So, what does an effective compliance program look like? At Parastar we believe that compliance programs need to include the following key elements.

  1. A Compliance Officer: This person must be of high enough rank within the organization that a commitment to compliance can be seen. The Compliance Officer should receive training specific to compliance.
  2. A Compliance Plan and Code of Conduct: Your Code of Conduct should encourage legal and ethical conduct and discuss your commitment to compliance.
  3. Compliance Reporting: Ensure that employees and others have a mechanism for reporting potential compliance violations without fear of retaliation.
  4. Training: Train everyone! And when you think you are done training, train some more. Your employees and board members don’t need to understand the intricacies of each law, but they do need to have a good understanding of how various laws apply to them and they need to be able to apply your internal policies. Offer training through employee newsletters, staff meetings, or other form of communication.
  5. A Compliance Committee: The Committee should consist of key members of your organization. Meet frequently to ensure that compliance concerns are identified and addressed. Use this group to further communicate your commitment to ethical and legal behavior.
  6. Monitoring and Auditing: Have internal staff monitor activities to ensure compliance with your policies. Have auditors review your claims and billing records.
  7. Follow Through: Investigate, track, and report potential violations and their outcomes. A list of potential violations and their outcome should be made available and reported to the Board of Directors.
  8. Enforcement: Enforce your policies and procedures. Retrain staff as appropriate and use corrective actions for violations.

Tracking to Ensure Compliance

Parastar helps to make documentation a central component of your compliance plan. We believe that accurate documentation on the operation of the compliance plan and of patient records is crucial. Medical record information provides the justification necessary to support claims payment. The medical record may be used to validate the site of the service, the medical necessity and appropriateness of the diagnostic and/or therapeutic services provided, and that the services have been reported accurately.

In the anatomy of a health provider organization, compliance tools are much like a muscle. In order to work more effectively, you need to put those them to use and dedicate resources in order to ensure an effective outcome.

For more information, visit the Office of Inspector General’s web site