Quality Assurance, Compliance, and Monitoring
The Office of Inspector General (OIG) first issued compliance guidance for physician practices almost 20 years ago, yet many practices still struggle with a cost-effective, pre-emptive approach, while keeping patient care the highest priority. The adoption and enhancement of a voluntary, well-designed compliance program can boost the practice’s ability to provide quality patient care, and demonstrates to the community that the practice has a strong commitment to honest and fair dealings, as well as sound business leadership. Additionally, a compliance program aids in mitigating risks associated with leading a medical practice, in addition to preventing fraud, waste, and abuse.
Whether you’re a seasoned provider of Telehealth services, or not, it will be prudent to include Telehealth services into your existing compliance program.
Seven Essential Elements of an Effective Compliance Program
An effective compliance program must be a continual process, and consists of the following seven elements:
- Written standards of conduct, policies and procedures
- Designation of a compliance officer or contact
- Effective education and training
- Monitoring and auditing
- Reporting and investigating- establishing open lines of communication
- Appropriate enforcement and disciplinary mechanisms
- Response, prevention, and corrective action of systemic problems
Every organization and practice is different, and there is not a “one size fits all” answer for compliance program effectiveness. A practice’s commitment to compliance can be evaluated by the active application of compliance principles and written standards, demonstrated in the practice’s day-to-day operations.
Here are a few items to consider for Quality Assurance and Compliance/Monitoring:
- Regular chart audits – conduct monthly, quarterly, or biannually depending on results of a baseline audit
- Random or targeted chart audits – examples include inpatient, outpatient, E/M (evaluation & management), outpatient surgery
- Provider documentation education – focus education based on audit results
- Coding audits and education – random audit of all chart types a coder has coded and provide education where needed
- Billing requirements – POS Codes/modifiers/payer requirements
- Pre-payment/post-payment audits – pre-bill avoids the potential of any paybacks relating to the audit
Dean Dorton’s healthcare consulting team would be happy to offer compliance program guidance, review the effectiveness of your existing compliance program, as well as assist you in building telehealth services into your current compliance program. Additionally, Dean Dorton has experts available to assist you in all telehealth matters including: compliance, billing, coding, and documentation.
Please do not hesitate to reach out to our experienced team with any questions you may have. We are committed to serving any of your healthcare needs.
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