Tips & Tools


Tips & Tools

The theme of this series focused on verifying if your compliance program is safe and meets government regulations. In this final tip, your program should always: […]

In this series, I shared that the government recovered five billion dollars from the healthcare False Claims Act in 2021, one of the most significant recoveries […]

In this series, I have already shared four ways healthcare leaders can verify their compliance program is safe, which leads to: #5: Implement and monitor Business […]

Studies show: Nearly 80 percent of medical claims that providers submit to payers have mistakes. Practices incorrectly code approximately 55 percent of evaluation and management claims. […]

Friends, did you know: The average HIPAA settlement fine is approximately $1.1 million. This average is only increasing as HHS becomes more aggressive in enforcing HIPAA […]

Previously I shared healthcare leaders must evaluate whether patients are a priority within their compliance program, which leads to: #2: Cultivating a culture of compliance among […]

Did you know the Department of Justice (DOJ) recovered over 5 billion dollars from the False Claims Act in 2021 from healthcare alone? And it’s just […]

Compare the DOJ’s compliance document to your compliance program and adjust. The final resource I would like to share from the series, The Comeback Story: 9 […]

Attend training hosted by the OCR to learn more about HIPAA. The eighth resource I would like to share from the series, The Comeback Story: 9 […]

Review the MLN and sign-up for a free training. In this series called The Comeback Story: 9 Compliance Resources to Level Up Your Practice, we are […]

Bookmark the Centers for Medicare & Medicaid Services (CMS) site. In our series called The Comeback Story: 9 Compliance Resources to Level Up Your Practice, I […]

Review and implement checking exclusion lists regularly within your practice. In Part V of our series called “The Comeback Story: 9 Compliance Resources to Level Up […]

Analyze and compare the OIG & HCCA Resource Guide to your compliance program. In our fourth week discussing, our series called The Comeback Story: 9 Compliance […]

Monitor the OIG’s Work Plan at least monthly Each week in our series called, The Comeback Story: 9 Compliance Resources to Level Up Your Practice, I […]

Examine the free educational resources developed by the OIG. In the last tip of our series, called The Comeback Story: 9 Compliance Resources to Level Up […]

Study the OIG Federal Register 2000. I was recently thinking about my high school graduation, and how much I dreaded my first college level math course. […]

Educate your staff about cybersecurity and breaches. As we end our series called “Compliant or Complacent: How to Upgrade Your Routine,” you must remain uncomfortable and […]

Examine top coding and billing risks within your practice. Did you know that studies show approximately 55 percent of evaluation and management (E/M) visits are coded […]

Audit your practice annually to avoid the exclusion list, penalties, and investigations. In the opening of our series called “Compliant or Complacent,” I shared why being […]

Brush off your compliance plan and increase your knowledge. I once saw this statement circulating on social media: Are you really happy or just really comfortable? […]

Ensure you re-review your policies regarding documentation, record retention, and patient requests. The last tip explained why understanding non-covered services is part of non-clinical duties, which […]

Evaluate insurance company’s guidelines on non-covered requirements and create policies. In our series called “Dear Provider: Don’t Give Up,” our last tip highlighted the issue physicians […]

Study and increase your knowledge of insurance company’s processes. The previous tip kicked off our series called “Dear Provider: Don’t Give Up,” highlighting the lack of […]

Implement new strategies and rebuild your accounts receivable program. 75 percent of respondents indicated non-clinical skills are more important than they were in the past because […]

 Send newsletters to patients sharing practice news and updates. As we end our series called 5 Compliance Concerns Your Patients Won’t Tell You, a common complaint […]

Monitor HIPAA and medical record trends to increase security. As you learned from the previous tip, understanding the patient’s concerns should always be top of mind. […]

Provide clarity around your billing statements. The last tip discussed the importance of accurate financial policies to help ease the concern of patients. And after you […]

Review and update your financial policy. In the last tip, we discussed the first compliance concern your patient won’t tell you, which leads into our second […]

Tip Series: 5 Compliance Concerns Your Patients Won’t Tell You A few years ago, I remember visiting an oral surgeon.  I had been holding onto my […]

Enact the “Three E’s of Reinventing” within your practice. As shared throughout the series, it is critical that your practice has a strategic compliance plan that […]

Review the OIG task list and activate. Before considering compliance activities or team roles, review strategies for implementation and monitoring; the wrong approach will make or […]

Reflect on the “Strategies to Reinvent Your Team” series. Compliance plan. Did you cringe? Did you stop reading? Don’t click off the screen just yet!  As […]

Monitor your practice communication and update annually.  After you have completed all the communication steps listed from our series called “The Blame Game: 5 Tips to […]

Develop employee’s communication skills through ongoing training. An excellent educational program should consist of various training types, such as in-person sessions, online courses, distribution of newsletters, […]

Devise a communication checklist. In the last post of our series called “The Blame Game: 5 Tips to Restore Practice Communication,” we discussed the importance of […]

Create communication policies and procedures. In Part II of “The Blame Game: 5 Tips to Restore Practice Communication,” one must truly understand the rules to end […]

Identify the root cause and establish a plan. Let’s face it.  Nobody likes to admit they have a communication problem. In some cases, it’s easier to […]

Restore your practice communication in five steps. Scheduler: Hello, John Doe’s Medical Clinic.  How may I assist you? Patient: Yes, I am calling because I am […]

Evaluate CMS’s new enforcement authorities to reduce fraudulent behavior. On Sept 5, 2019, CMS announced new enforcement authorities to reduce fraud within Medicare, Medicaid, and CHIP. […]

Enforce disciplinary standards through well-publicized guidelines. In element six, we discussed promoting open lines of communication, which is part of the 7 Elements of an Effective […]

Develop open lines of communication. Open communication between staff, patients, and patients’ family is essential when building an effective compliance program. Did you know communication failures […]

Respond appropriately to detected offenses and develop corrective action plans within your practice. As discussed in our previous tip, we shared the 7 Elements of an […]

Conduct appropriate training and educate your entire practice regarding compliance regulations. In our last tip, we discussed the 7 Elements of an Effective Compliance Program, in […]

Designate a compliance officer or contact that will assist you with building an effective compliance program. In the last few tips, we have been discussing the […]

Implement compliance and practice standards within your practice. As shared in our previous tip, all practices should follow the 7 Elements of an Effective Compliance Program, […]

Ensure that your practice is conducting internal monitoring and auditing regularly. As stated in our previous tip, it is important that all practices follow the 7 […]

Interpret and apply the “7 Elements of an Effective Compliance Program” for individual and small group physician practices. The goal of the OIG compliance guidance is […]

Discuss the Exclusion Statute with your management team.  And, check the exclusion list (LEIE) at least monthly. What is the Exclusion Statute? Per the OIG, under […]

Review the Stark Law and examine your referral relationships with designated health entities. In our previous tip, we discussed the importance of understanding the Anti-Kickback Statute […]

Examine the Anti-Kickback Statute (AKS) and determine whether your practice is in violation. The Anti-Kickback Statute (AKS) can be difficult for practices to understand if one […]

Research the False Claims Act (FCA) and share with your staff how it applies to your practice (with examples). In the next few posts, we will […]

Post the definition of abuse and share examples with your team. Now that we talked about fraud in our previous tip, let’s go into the definition […]

Reflect on the definition of fraud and share the examples with your team. Now after hearing the OIG disclaimer in our previous tip, let’s go further […]

Review and reflect on the OIG’s thoughts about the difference between “erroneous” and “fraudulent” claims. In this tip, we want to provide you all the OIG […]

Explain the benefits of a compliance program and share resources with your team. We always share the importance of compliance plans; however, here are a few […]

Review the HHS and OIG’s breach notification requirements to ensure HIPPA compliance. Per HIPAA, “a breach is defined as an unauthorized acquisition, access, use, or disclosure […]

Assign an employee or hire a Privacy Officer to develop and monitor your HIPAA-compliant privacy program. Per HIPAA, it is required that privacy personnel are designated […]

Create policies and procedures regarding patient requests and disclosures. Patient requests under HIPAA provide individuals the right, under certain circumstances, to access, inspect and obtain copies […]

Examine your marketing practices to ensure HIPAA compliance. Did you know HIPAA created limitations around using PHI for marketing purposes? Under the Privacy Rule, marketing is […]

Review and share the key components of HIPAA with all employees and patients. We know that most of you are familiar with HIPAA; however, reviewing this […]

Get serious about HIPAA. The Health Insurance Portability and Accountability Act of 1996 or HIPAA is a law that is designed to protect patient medical information.  […]

Complete annual inspections and walkthroughs regarding exit routes, fire and emergency safety plans, and OSHA signage. In our OSHA Series, we talked a lot about safety […]

Review and apply OSHA’s “Recording and Reporting Occupational Injuries/Illnesses Standard” to your practice immediately. The standard was created to require employers to record and report work-related […]

Assess and test your employees regularly about personal protective equipment (PPE) removal guidelines. Quality is a key aspect of healthcare, which is directly connected to how […]

Evaluate your exposure control plan annually. A written exposure control plan intends to focus on the bloodborne pathogen standard, which guides how to protect your employees […]

Identify and train staff on the Bloodborne Pathogens Standard.  OSHA defines the term healthcare worker as paid and unpaid persons who have the potential to be […]

Get serious about OSHA. OSHA is one of the three agencies created by the Occupational Safety and Health Act of 1970. The Occupational Safety and Health […]

Study and implement the OIG’s “7 Elements of an Effective Compliance Program” for your industry. The OIG has developed a series of compliance documents for the […]

Create an Advanced Beneficiary Notice of Noncoverage (ABN) policy/procedure and share with your team. Do you know how to use an Advanced Beneficiary Notice of Noncoverage […]

Schedule a meeting with your insurance provider relations representative. Did you know compliance issues can arise due to not understanding insurance contracts?  Do you know the […]

Examine your write-offs and use the information to improve the financial health of your practice. Did you know your write-offs will provide clues of how successful […]

Reevaluate the payment experience for patients. Each year InstaMed releases their Trends in Healthcare Payments Ninth Annual Report. In this tip we would like to discuss […]

Query your third-party billing company regularly. A common issue we see practices face with third-party billing companies is the “set it and forget it” mentality. When […]

Review proper disposal of PHI according to the ‘HIPAA Security Rule.’  And, connect with vendors, educate, and train your employees. On busy days, HIPAA regulations are […]

Create a patient registration policy and procedure. Sadly, we find that practices assume that employees automatically understand the patient registration process. And, this is not the […]

Review your insurance contracts for information about professional courtesy and waivers of payments.  And, consider creating a financial hardship policy. A common compliance concern is waiving […]

Create monthly healthcare compliance newsletters. Since this is the last tip of our employee engagement series, we would like to add the importance of communication through […]

Launch a ‘Lunch & Learn’ program. We have seen significant success with enacting a ‘Lunch and Learn’ program.  Not only does it give employees a chance […]

Give small gifts to show employee appreciation. Did you know, per a Randstad survey, the top reason for leaving a job is due to lack of […]

Celebrate compliance “wins.” To continue our discussion about employee engagement, after you explain the ‘why’ through real-world training examples, assigned compliance duties, and quarterly one-on-one meetings……this […]

Schedule one-on-one meetings with staff quarterly. Statistics show one reason why employees are disengaged at work is due to receiving little to no feedback from management […]

Involve staff in compliance training. First, allow us to paint the picture of how we have seen some compliance training go: Watch a video. Read a […]

Explain the ‘why’ behind healthcare compliance to your team.   Have you ever heard the saying “death by PowerPoint?” This same statement can easily transfer to […]

Determine which employees are “disengaged” within your practice and start brainstorming ways to increase their engagement.  Per an August 2019 Gallup Poll about employee engagement, they […]

Implement security measures on all laptops associated with your practice.  A report by Clearwater Cyberintelligence Institute found that laptops still pose the greatest risk for cyberattack […]

Educate employees about data breaches and acceptable behaviors when sharing data. A survey by Insider Data Breach asked more than 4,000 employees their thoughts on data […]

Develop a medical record request and retention policy to address state and federal laws. An article posted by HIPAA Journal shares the Dental Board of California […]

Evaluate your business associate agreements (BAA) to ensure PHI is appropriately safeguarded. In Feb 2019, per the HIPAA Journal, a vendor that provides secure electronic exchange […]

Ask your patients what privacy issues they see, especially regarding the EHR system. Patients see more than you think. According to the Kaiser Family Foundation’s poll, […]

Review, provide real-world examples, and quiz your staff about the most common medical coding errors identified by the American Medical Association (AMA). Here are 8 of […]

Send an email to your staff and discuss the Joint Commission’s article called the “Top 10 Most Frequently Reported Sentinel Events in 2018.” Last week, the […]

Hire a consultant to perform an annual compliance program risk assessment to measure effectiveness. As we end our review of SAI Global and Strategic Management’s “2019 […]

Verify that your compliance program priorities align with the government. From the SAI Global and Strategic Management Services “2019 Healthcare Compliance Benchmark Report,” they found: 77% […]

Use surveys to measure the effectiveness of your compliance program. Per the SAI Global and Strategic Management Services “2019 Healthcare Compliance Benchmark Report:” 64% have not […]

Enforce that your management team follows compliance provisions and train employees appropriately. Practice owners, how often do you verify whether your management team is following government […]

Hire vendors to ensure your employees are not on the OIG, GSA, or state exclusion list. In this post, we will continue to discuss our findings […]

Publicize your hotline.  And, reiterate failure to report errors or fraudulent conduct is a violation of the compliance program. Per the SAI Global and Strategic Management’s […]

Train at new employee orientation and annually thereafter. Per the SAI Global and Strategic Management’s “2019 Healthcare Compliance Benchmark Report,” healthcare organizations are facing challenges in […]

Develop written compliance policies and procedures. Per the SAI Global and Strategic Management “2019 Healthcare Compliance Benchmark Report,” they found that: 39% of entities manage their […]

Increase your compliance budget. Per SAI Global and Strategic Management “2019 Healthcare Compliance Benchmark Report,” only 29% of entities expect to increase their compliance budgets in […]

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