Essential Elements for Effective Healthcare Compliance Programs

1. Essential Elements for Effective Healthcare Compliance Programs

2. As per the National Healthcare Anti-Fraud Association or the NHCAA, the financial loses from healthcare frauds are in tens of billions dollar every year, In the year 2013, the USA HHS as well as the Department of Justice did recover upwards of $4.3 billion in the healthcare fraud and healthcare abuse. • With increasing rates of medical fraud, healthcare providers could expect to notice an increase in the governmental audits, Medicare investigations and audits.

3. As for medical practices, the first line of proper defense is having an effective compliance program. the purpose of healthcare compliance program is promoting prevention of any criminal conduct, enforcing government regulations and rules, all the while providing a better quality of healthcare to patients. • Healthcare compliance programs could help protect the practices against any improper payments, abuse and frauds, and any other potential areas of liability. Under ACA, group practices and physicians are needed to establish healthcare compliance programs as one condition of having themselves enrolled in a Medicare program. • Also, a lot of commercial insurance plans are requiring healthcare providers to have compliance plans as conditions of participation.

4. With the fraud enforcement initiatives constantly increasing, the medical practices which haven’t yet implemented healthcare compliance Las Vegas plans risk exclusion from the commercial insurance plans as well as from government healthcare programs. • As per CMS, implementation of good compliance programs would aid in a much better protection to practices from risks of improper conducts.

5. ACA has 7 core elements for effective compliance program: • Identification & appointment of an individual or within the organization to serve as a compliance officer, who would be responsible for fully monitoring the compliance efforts as well as enforcing the practice standards. • Establishment & adoption of the written policies as well as procedures so as to promote the commitment of the organization to healthcare compliance, as per healthcare business and corporate law. • Establishment of the reporting systems to always encourage individuals to make due complaints regarding any compliance item(s) without any fear of retaliation.

6. Ongoing auditing & monitoring of systems in order to assess the very effectiveness of compliance programs and also to identify issues. • Commitment to conducting of formal education as well as training programs for each levels of employees. • Whenever vulnerabilities are identified, necessary corrective actions must be taken in response to the potential violations. • Development of policies so as to enforce the standards of conduct and with disciplinary measures for the employees who fail to properly comply with requirements.

7. By implementation of a comprehensive healthcare compliance program, a healthcare practice could find as well as correct potential vulnerabilities, all the while minimizing their billing mistakes, increasing the payment of claims, reducing the chances of an audit, promoting quality and safe health care, and reducing the chances of abuse and fraud. • The health care provides and clinics that haven’t yet implemented a healthcare compliance plan must utilize the above-mentioned seven core elements for effective compliance program, as a foundation. Hiring professional to do the same would do you only good.

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