Compliance Plan Breakout

Compliance Plan Breakout

AMBA 2019 National Conference Session Recap

Compliance Plan Breakout – Written by Stephanie Cremeans of EZClaim

Any provider that is treating Medicare or Medicaid patients is required to have a compliance plan for their practice. This is mandated under the Patient Protection and Affordable Care Act of 2010.

The Office of Inspector General (OIG) has established an outline of seven components to help the small or individual provider offices get started. They also understand that small practices don’t typically have extensive resources creating and establishing a plan, and encourage practices to start with one item, making the compliance plan a working document that is updated and added to as necessary. The seven components are as follows:

  • Conduct internal monitoring and auditing
  • Implement compliance and practice standards
  • Designate a compliance officer or contact
  • Conduct appropriate training and education
  • Respond appropriately to detected offenses and develop corrective action
  • Develop open lines of communication with employees
  • Enforce disciplinary standards through well-publicized guidelines

Let’s dig in a bit to the first component, conducting internal monitoring and auditing. Starting with this step will help a practice lay the groundwork of its compliance plan and shed light on areas that need additional work. There is no set number of records that are required to be audited, rather a suggestion of 5 (or more) per provider annually for a small or solo practice. You can start your compliance plan by simply documenting that no less than 5 charts per provider will be audited annually. Keep track of the results and use them to start implementing other components. For instance, you have the audit results, but what is considered passing? What are you going to do if a provider isn’t compliant? Document the answers and you are building your plan. Did the audit show specific areas for improvement? Find applicable training or host training for those that need it, document it in your plan. Did you find overpayments? Document how these are to be handled, resolve it quickly and put policies in place to prevent a bigger problem.

By taking steps to create a compliance plan and show a good-faith effort to improve on risk areas your practice will reap the benefits of clean claims with a reduction in denials, fewer billing errors and the assurance that your records are ready for an audit. This will also reduce your risk exposure to fines.

For help getting started with that first audit, setting benchmarks and improvement plans or for education on problem areas contact RCM Insight. For additional assistance with building your HIPAA compliance plans contact Live Compliance.

If you are enjoying the informative content we’re providing and have a specific topic you would like to see covered, we would love to hear from you! Please feel free to send along your ideas via email to sales@ezclaim.com.

AMBA National Conference Overview

AMBA National Conference

AMBA National Conference Overview – Written by Stephanie Cremeans and Dan Loch of EZClaim

EZClaim, represented by Stephanie Cremeans and Dan Loch, was proud to exhibit at the American Medical Billing Association’s AMBA National Conference last week in Las Vegas at Planet Hollywood. The AMBA team had things ready to go when we got there and made sure we had what we needed throughout the event.  

The AMBA National Conference attendees seemed to have fun and were fully engaged with the exhibitors. Many thanked us for our support of the event as well. The attendees supplied the vendors with good traffic from start to finish. Stephanie and Dan were able to spend some quality time with the attendees speaking about their struggles, needs, and ideal functionality to help improve their billing service.

During slower times EZClaim was able to interact with some of the other exhibitors and sponsors of the event for an added benefit. This is a conference that EZClaim will be returning to in October of 2020 at Caesars Palace in Las Vegas.

Stephanie was able to attend a few of the sessions as well. There was a wide variety of topics covered including specialty-specific information for Acupuncture and Chiropractic billing, coding and billing compliance and the importance of conducting internal coding audits. These topics were informative and presented by dynamic speakers that made the information relatable. Stay tuned as we bring you our key takeaways from these very informative sessions.

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