Third on the list of practice risk is quality reporting, because national agencies have a growing concern about quality coding for private practices. Two quality data reporting programs with the potential for a major impact on practices include PQRI and meaningful use. The government has made no secret about the importance of reporting quality data despite the challenges of staff resources or technology to capture the required information.
Manage the Risk
Managing compliance can be a challenge for physician practices, but reducing risk and capturing areas of benefit begin with a focus on the areas of greatest concern. Although HIPAA, coding and data reporting pressures continue to climb while revenues drop and operational costs increase, practices must keep current with new regulatory developments to ensure quality patient care, profitability, improved outcomes and protection against penalties.
Practices can demonstrate due diligence and targeted goals for developing a formal compliance program, even with minimal resources. A list of the core elements expected in a practice compliance program includes:
- Conducting internal monitoring and auditing through periodic audits;
- Implementing compliance and practice standards through the development of written standards and procedures;
- Designating a compliance officer or staff liaison to monitor compliance efforts and enforce practice standards;
- Conducting quarterly or bi-yearly training and education on practice standards and procedures;
- Responding appropriately to any known violations;
- Developing open lines of communication, such as
- discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct and
- community bulletin boards, to keep practice employees up to date regarding compliance activities; and
- Enforcing disciplinary standards through well-publicized guidelines.
Practice improvement efforts to create or renew a compliance program must focus on strengthening compliance while improving staff performance and supporting quality patient care.
For additional information or questions on healthcare compliance programs or training to reduce risks or how to respond to denied reimbursement and audits, contact the ACR practice management department at [email protected].
Reference
- O’Keefe J. Insist on certification. Healthcare IT News. 2009 May.
