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Make 2015 a Better Year: Easy Compliance Resolutions

Posted by Margaret Scavotto, JD, CHC on 1/13/15 11:47 AM

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Use these lessons from 2014 to make your 2015 a better year. Ready...Set...Go!

1. You are only as strong as your employees.

Health care providers don't commit compliance violations--their employees do. Your compliance program should have policies, procedures, and training designed to help your employees do the right thing; audits of your policies and procedures in order to make sure your employees are doing the right thing; and discipline standards that apply when people don't do the right thing. 

But how do we motivate employees to do the right thing when no one is looking? After all, most of the time, no one is looking. Do your employees know how to recognize non-compliance…and how to report it internally? Do your employees understand when a perk or gift is an illegal kickback? When the use of social media violates HIPAA? When the way they speak to a resident violates resident
rights? In 2015, make compliance education and training focused around one goal: helping employees do their jobs the right way.

2. No more finger pointing.

Too many nursing homes skimp on therapy audits, believing the therapy company is responsible for the accuracy of the claim. 2014 showed us that this view is wrong: nursing homes are increasingly being held responsible for, and expected to prevent, the false claims of their therapy contractorsAs part of their compliance program's billing and claims audit strategy, nursing homes should include a review of therapy claims and their supporting documentation.

3. Know your data.

The government is finding more effective uses of data analysis to evaluate providers and recoup false claims. CMS uses PEPPER reports to compare your SNF to others and identify if you are an outlier at risk for improper payments in areas such as therapy RUGs and change of therapy assessments. In other words, the government is mining your data and evaluating your claims—and so should you. By incorporating PEPPER data into your compliance auditing strategy, you can identify potential areas of non-compliance that could make you a government target.

Data analysis is no stranger to the OIG, either. The OIG's use of data analytics recently identified 5 excluded providers at a Texas long term care company. It is easy for the OIG to identify excluded providers using data analytics. Fortunately, it is also easy for providers to screen their employees. Are data analytics part of your auditing strategy for 2015?

4. Budget for compliance or budget for penalties.

Enforcement of compliance related laws is profitable for the government, and it's not going away any time soon. Today's health care world sees more penalties, on more providers, often involving inadvertent conduct. From aggressive HIPAA enforcement to 7-figure privacy privacy lawsuits to nursing home settlements, penalties are becoming a reality for more and more providers. It's a lot less expensive to budget for compliance than it is to budget for a 6 or 7 figure penalty!  Download MPA's free whitepaper: Compliance Saves Money.

5. We are in this together.

As enforcement becomes more common, we are seeing more of our neighbors in the headlines. The government is an equal opportunity enforcer, and we are all in this together:  not-for-profits, public providers, religious providers, chainssmall providers and even individuals.Perhaps the most important thing providers can do in 2015 is realize that non-compliance can happen to anyone--and everyone should be taking steps to prevent it with a strong compliance effort.

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