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Recent Industry News

Compliance Programs

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Health care organizations face ever increasing regulations.  To effectively mitigate the risk of exposure to actions by government regulators or enforcement authorities, health care organizations should develop a proactive approach in their compliance program execution.  Government authorities are pursuing aggressive investigations and corrective actions to hold entities, and responsible corporate executives, accountable for corporate compliance failures.  Having an effective compliance program is essential to an organization’s ability to prevent and detect misconduct that could lead to liability exposure.  Despite the abundance of guidance pertaining to corporate compliance, achieving a compliance program that is effective in reducing events or actions that could give rise to liabilities remains a continuing challenge.

Health care Compliance Officers may wish to consider the following tips for achieving program effectiveness during the course of their organization’s annual program monitoring and evaluation:

  1. The charter for the Compliance Officer function should provide proper empowerment and authority;
  2. The board meeting and executive oversight committee minutes should document evidence of proper compliance program support, reporting processes, and oversight;
  3. A clear, consistent, and highly visible message should convey the organizational compliance responsibilities applicable to all members of the workforce team, regardless of position;
  4. Program managers should engage in ongoing monitoring and oversight for their respective areas, including risk identification processes, policies and protocols to address identified risks, regular staff training incorporating compliance program priorities, and verification of adherence to compliance program policies;
  5. The Code of Conduct (Code) should be written as the “Constitution” supporting the compliance program, setting forth the commitment to patient service, including staff performance expectations for the delivery of safe patient services, safety in the workplace environment, and adherence to applicable laws, regulations, and standards;
  6. The Code should be communicated in understandable terms for all employees, written at the 8th grade level of education;
  7. Policies and procedures should provide descriptions of behavior consistent with adherence to the Code;
  8. The Code should stipulate a clear process of progressive disciplinary actions for behavior or actions deemed to be inconsistent with the Code.
  9. Compliance program-related policies and procedures should be reviewed and updated on a scheduled basis;
  10. Document management systems should track changes, revisions, and rescissions in policies and procedures;
  11. The organization should provide adequate written compliance guidance for all risk-related aspects of organizational operations;
  12. Organizational documents should evidence executive management responsibility for compliance program support;
  13. Corporate documents should evidence adequate support (including financial and organizational resources) for the compliance program;
  14. Periodic independent assessments should provide evidence of compliance program effectiveness;
  15. The organization should quickly remediate and document all deficiencies found in compliance surveys and program reviews through a compliance action plan;
  16. The Compliance Officer should perform periodic quality assurance audits of the compliance hotline to ensure calls are properly answered and accurately reported;
  17. The organization should develop and analyze appropriate metrics to confirm effectiveness of the compliance hotline and other channels of communication available for reporting compliance concerns;
  18. Compliance training and education should effectively convey organizational commitment to compliance;
  19. The organization should deploy periodic surveys to provide evidence of employee understanding of the compliance program;
  20. The company should provide periodic compliance training and internal certification for all employees with documentation maintained through the Compliance Office.
  21. Compliance Billing and Coding policies should address timely self-disclosure of overpayments and potential violations of compliance regulations or laws;
  22. Periodic compliance reports to key staff members and executive level management should include a process to capture lessons learned from costly errors resulting from compliance weaknesses;
  23. Compliance Officers should execute planned schedules for periodic audits to evaluate compliance effectiveness in high risk areas, followed by a program of corrective actions for identified areas of concern;
  24. Compliance Officers should deploy periodic surveys of employees and providers to measure and analyze organization-wide understanding of compliance program initiatives, and the organizational culture of compliance; and
  25. Human Resources should include key components of compliance as an element of performance evaluations and compensation decisions.
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