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Compliance plan.

Did you cringe?

Did you stop reading?

Don’t click off the screen just yet!  As a practice owner or manager, I know building or monitoring a compliance plan, on top of running a busy practice, can become a massive undertaking.  You have probably read numerous articles, listened to countless presentations, and received visits from consultants demanding the importance of a compliance plan.

Yet, you still struggle with the motivation to start or maintain one.

What if I shared that you could delegate compliance responsibilities to someone else?  What if I gave you an easy plan that will have the entire practice slow-clapping after completion?

In this post, allow me to introduce the Office of Inspector General (OIG) thoughts on compliance plans, team strategy suggestions, and the “Three E’s” to reinvent your compliance team.

“The Dog Ate My Compliance Plan”

The federal and state government are strategic regarding the role compliance plays in your practice.  Excessive errors will red-flag the government, and when they show up requesting an audit, it’s best to have a compliance plan to disprove their claims.

Unfortunately, they don’t want to hear excuses, such as:

 “It’s hard building an effective program.”

“The dog ate my compliance plan.”

“We don’t have enough resources.”

“No time to create one.”

They stick by their regulations….plain and simple.  If you don’t believe me, check out the OIG website, which highlights individuals and organizations that landed on the exclusion list, received harsh penalties, and, in some cases, jail time.  Even though they are suffering the consequences, the good news is you can learn from their mistakes and build a successful compliance plan immediately.

Before initiating, it is critical you recognize your key team players that will handle the day-to-day functions of the compliance program.  The OIG suggests you:

1) Hire a compliance officer;

2) Split tasks among employees;

3) Designate one person from the practice to correspond with an outsourced compliance officer or consultant.

As you can see, the OIG acknowledges that practices may not have the funds to hire a compliance officer or consultant, which is why they suggest utilizing current employees to build an effective program.  In my recent blog post, I shared survey statistics regarding employee thoughts on seeking career development and progression, which can be used to your benefit when assigning compliance tasks.

My thoughts: Use the OIG suggestions regarding split tasks, research how you want your team structured, review employee feedback, and take or assign compliance courses to increase team knowledge.  Your goal is to build a compliance team, where everyone works together to protect the practice, rather than suffering from burnout completing it alone.

Strategy: OIG Task List

When considering compliance activities or team roles, review strategies for implementation and monitoring. A strategy will make or break your practice, especially if you are subject to an OIG investigation.  Remember, the OIG can tell who left their compliance plan on the shelf “to collect dust.” Ensure it is fully functioning and your employees are following it verbatim.

The OIG Federal Register year 2000 is the suggested guide all physician practices should utilize when building an effective compliance program.  In this Register, the OIG provided a list of six strategies to start your team on the road to success.  As always, tailor the list to your specialty.  The team strategies are:

#1:  Implementation

Overseeing and monitoring the implementation of the compliance program.

#2:  Auditing

Establishing methods, such as periodic audits, to improve the practice’s efficiency and quality of services and to reduce the practice’s vulnerability to fraud and abuse.

#3: Training

 Developing, coordinating, and participating in a training program that focuses on the components of the compliance program and seeks to ensure training materials are appropriate.

#4: Exclusion List Review

 Ensuring the HHS-OIG’s List of Excluded Individuals and Entities and the General Services Administration’s (GSA’s) List of Parties Debarred from Federal Programs have been checked, regarding all employees, medical staff, and independent contractors.

#5: Investigation & Corrective Action

 Investigating any report or allegation concerning possible unethical or improper business practices and monitoring subsequent corrective action and/or compliance. 

#6: Monitoring

 Periodically revising the compliance program, considering changes in the needs of the practice or changes in the law and the standards and procedures of Government and private pay or health plans.

The Three E’s of Reinventing

What I value about the strategies above is they get your mind churning and provide a blueprint.  However, I want to share my “Three E’s” to reinvent your team, such as:

Explain the “why” behind healthcare compliance

  • In my mini eBook, I share how critical it is to explain the “why.” Employees forget or lose interest if they do not see the meaning behind what they are doing or where they fit into the process.  Therefore, before assigning tasks, explain the new plan to your employees and why their involvement is necessary.  To make your job easier, soliciting their thoughts will include them in the blueprint phase and boost employee motivation.

Evaluate your employee’s strengths and weaknesses

  • Evaluate your employees before assigning compliance tasks. Understanding this area will ensure they are qualified or allows additional time for compliance training.  To access this area, you can review previous performance reviews, issue skill set or personality tests, resumes, interviews etc.  Another suggestion is to hire an outside consultant to assist with compliance plan set-up or training, because they will foresee and rectify any challenges you will face.

 Examine the areas of possible bias

  • Remember certain parts of your compliance plan may pose a conflict of interest. You want to review your employee’s job titles carefully to ensure they are unbiased in their assigned compliance duties.  It’s not a best practice to have the coder oversee the auditing section due to potential bias in audit results.  It may be beneficial that they assist with auditing policies and procedures only and allow an outside source or management to perform the actual audit.

After utilizing my “Three E’s,” always be on the lookout for new or updated strategies while building or maintaining a compliance plan.  You can be creative with the layout and the tasks you assign your employees.  The main objective is to ensure the plan makes sense and is beneficial to the entire community (i.e., patients, employees).

Do you remember when I suggested tailoring compliance tasks to your specialty?  As a gift, I created a Compliance Starter Kit to be used immediately within your practice.  This list will aid you in training and assigning tasks; I also placed a star next to the role of management or consultant.  Last, monitor performance and switch tasks quarterly to counteract employee burnout.

Conclusion

Since you didn’t click off the screen after I mentioned “compliance plan,” I would like to remind you:

YOU CAN DO IT!

I know implementing and monitoring a compliance program is tough, and government scrutiny doesn’t make it easier.  Your compliance plan and team set-up need not be perfect, but it must show you are putting a “good faith” effort towards maintaining one.

The good news is, you don’t have to shoulder the burden alone.  Your willingness to reinvent your team and make employee career goals your focus through development and progression speaks volumes.  A happy and collaborative team equals reduced errors, which leaves you time to relax and focus on other job functions.

**The opinions and observations from the author are not a promise to exempt your practice from fines and penalties.  Research, modify, and tailor the advice to fit your specialty.
Joi Sherrod, MPH, CPC, CPCO
Joi Sherrod, MPH, CPC, CPCO
Joi is an educator and owner of JNC Healthcare Compliance Group, LLC. After working for prominent academic teaching hospitals and clinics, she is passionate about advising medical and dental practices regarding the world of healthcare compliance. Contact Joi at info@jnccompliance.com.

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