PROACTIVE TIPS FOR HEALTHCARE REFORMHEALTHCARE REFORM IS HERE AND COMPLIANCE LIABILITY IS A PRIORITY FOR MANY REGULATORY AGENCIES.
MEDICARE PRACTICES MUST MAKE A COMMITMENT TO REVIEW THEIR PRACTICE POLICIES IN 2014.
Here are a few proactive tips we recommend to our clients:
1. A compliance program is now required by any provider that bills Medicare, Medicaid, and/or programs funded by federal or state governments. “Compliance program” in these terms relates to HHS’ Office of the Inspector General’s (OIG) compliance guidance on billing, coding, contracts, and relationships which is now required under the Affordable Care Act. There are approximately 40 policies, that include screening all employees against state and federal exclusion databases.
2. Conduct a professional third party review of any joint venture, employment work contract, and leases for potential Stark and Anti-Kickback violations. OIG will be reviewing contractual relationships as part of the compliance work plan.
3. Ensure your staff knows when it is appropriate to bill “incident-to” the physician and when to bill under the mid-level. This has been a huge audit item for Medicare and commercial plans.
4. Chart documentation is critical. It must be legible by three people to be considered valid. The documentation must warrant the billable services submitted. Not Every office visit is a level 3-4-5 service. If you have high-risk cases, then use appropriate diagnosis coding.
5. Meet at least quarterly with your biller to review summary reports of revenue, accounts receivable aging by payer, write offs, and denials.
Contact us For assistance in developing a compliance plan or conducting an internal review of your practice