7 Elements of an Effective Compliance Program [Healthcare Compliance Tips]

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 to make sure the patient is priority. And, in our previous tip we highlighted the Compliance Program Guidance for Individual and Small Group Physician Practices.

In their documents, the OIG expresses the importance of a well-designed plan which will be integral to reducing medical errors, better medical record documentation, enhanced patient outcomes, and much more.

They believe that a great majority of physicians are honest and want to protect the integrity of government healthcare programs.

However, creating a good compliance plan lets the OIG see that you are putting a “good faith effort” to submit claims appropriately, which in turn can reduce extensive investigations or even fines.

Also, an effective compliance plan allows the community to see that you care about making sure you are compliant and effectively protecting their information.

As you are learning, please do not stress yourself out because there is no “one size fits all” plan.  The OIG even states they are ok with you using other provider’s or hospital policies and procedures as a template, but keep in mind that it should be tailored to your practice needs.

In the next seven tips, we will discuss the 7 Elements of an Effective Compliance Program, which are:

• Conducting internal monitoring and auditing
• Implementing compliance and practice standards
• Designating a compliance officer or contact
• Conducting appropriate training and education
• Responding appropriately to detected offenses and developing corrective action
• Developing open lines of communication
• Enforcing disciplinary standards through well-publicized guidelines

Again, the elements were created to give practices a starting point, in which you can add additional policies if you feel it will be more effective.

You do not have to implement all seven immediately since the OIG is aware of lack of funds or employees, but it is best to use a step by step approach to get started.

Remember, be careful not to make your compliance program too complex because the OIG will hold you to this standard.

**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify, and tailor the advice to fit your specialty.