Design a compliance plan for the medical office

The Affordable Care Act has mandated that all physician offices will need to have a compliance plan and compliance point of contact. Although the Office of Inspector General has not yet set the date, now is the time to get ready and design a compliance plan for your medical office. Fraud, waste, and abuse are at an all-time high. The government and taxpayers want to plug the holes where valuable healthcare dollars are being inappropriately used. Be proactive and take the time to design your compliance plan now. Read on to learn how to remove the question of "who, what, and I don't know" from your vocabulary when it comes to the topic of compliance!

The seven elements of a payable claim

Healthcare providers are obligated to comply with a wide range of statutory and regulatory requirements associated with the provision, documentation, coding, and billing of a medical claim. It is important to keep in mind that the viewpoint of an outside auditor is not going to be the same as that of the treating physician. For instance, when documenting medical services, the information viewed as most significant (and therefore recorded) by a treating physician may be very different from the information an outside auditor hopes to glean from a patient's record. As a result, a significant disconnect between the parties may occur. To avoid this, it is essential that a treating physician or other healthcare provider diligently work to help ensure that claims submitted to Medicare, Medicaid, or a private payer fully comply with all applicable coverage and payment requirements. We have developed a checklist that we refer to as "The Seven Elements of a Payable Claim" to assist providers in this effort.

Sustainability in medicine

Given the current state of the U.S. healthcare system, with increasingly complicated regulations and paperwork and decreasing reimbursements, the question arises: Is it possible to provide safe, high-quality healthcare and reduce costs? Furthermore, is it possible to care for the health of your patients while simultaneously caring for the financial health of your practice and promoting improvement in the overall health of the planet? This article will review some steps currently being taken by various companies and hopefully stimulate ideas for changes you may want to consider for your own practice, hospital, or institution.

It was just a joke: improper comments and practice liability

There can be a fine line between humor and harassment, and that line is now frequently explored in litigation. A racial, sexual, or ethnic joke or bullying comment is not nearly as funny in the courtroom as it was in the break room. In addition, a practice's owner or partner can be utterly undefendable. This article casts light on crucial issues of workplace humor, banter, and liability.

What to do before the office for civil rights comes knocking: Part II. Coping with breaches, enforcement, and other fallout of HIPAA: the significance of harm

Physicians and their lawyers must review business associates that are subject to HIPAA and must revisit their HIPAA privacy and security efforts to comply with the new rules. In particular, they must: (1) review and revise their HIPAA privacy and security notices, policies, administrative materials, and training manuals; (2) review, negotiate, and revise their business associate agreements; and (3) train any employees who have access to PHI with respect to the changes to HIPAA's rules as a result of ARRA.