It’s federal law that Medicare and Medicaid plans must implement effective compliance programs. The purpose of the compliance guidelines are to ensure that all entities who contract with Medicare and Medicaid are properly observing all applicable state and federal laws. This helps prevent fraud and abuse in the billing process.
For those healthcare providers who are in need of implementing the compliance program, especially if they’ve been operating under a different set of rules, the process can seem overwhelming and confusing. Fortunately, there are resources available to help break it down into manageable parts. Here are five go-to free resources for information on making sense of (and completing) compliance program requirements.
1. Harmony Healthcare International offers compliance resources for healthcare providers, including information on why corporate compliance matters and how specific functions of Medicare and Medicaid factor in.
2. Legal language is inherently convoluted, greatly increasing the difficulty of understanding the compliance measures. In this article from The Health Law Firm, attorney George Indest III breaks down the language into easy, understandable pieces. In addition, Indest covers the compliance guidelines as they specifically apply to small medical practices.
3. The website for the Centers for Medicare and Medicaid Services has made available provider compliance resources that include an overview of compliance educational products and methods healthcare professionals can use to make sure they are billing within the law.
4. Through the Office of the Attorney General’s Compliance 101 material, physicians and other providers can find lots of helpful information on abiding by the compliance laws. These include video and audio podcasts that cover the basics of healthcare compliance programs, from avoiding fraud and abuse to taking the right steps when a compliance issue does arise.
5. Another useful tool offered by the Office of the Attorney General is a document for healthcare governing boards on compliance oversight. In it they discuss expectations for board members, tips for identifying and auditing areas of potential risk, and advice on accountability—all in easy to understand language.
If you’re still not really sure what the compliance guidelines mean or how to implement them, a number of paid services exist that can help you modify your existing billing