JNC Healthcare Compliance Group

Tip: Evaluate CMS’s new enforcement authorities to reduce fraudulent behavior. On Sept 5, 2019, CMS announced new enforcement authorities to reduce fraud within Medicare, Medicaid, and CHIP. The new authorities and restrictions will be effective by November 4, 2019, in which CMS can revoke or deny the enrollment application due to the following:... A provider or supplier circumvents program rules by coming back into the program, or attempting to come back in, under a different name (e.g., the provider attempts to reinvent itself); A provider or supplier bills for services/items from non-compliant locations. To review the other two restrictions and tip, click Compliance Tips & Resources in the bio/about link! P.S. Don’t forget to hit the save button, tag a colleague, book a free appointment, or grab our compliance kit (see bio/about)! Our 2019 motto: It’s time to enact!

Tip: Develop open lines of communication. Open communication between staff, patients, and patients’ family is essential when building an effective compliance program. Did you know communication failures account for 30% of the malpractice cases? Per CRICO Strategies, this is equivalent to nearly 2,000 patient deaths that can be avoided if medical staff improved their communication. ... As management, you can avoid this by enacting the sixth element of the 7 Elements of an Effective Compliance Program, which is developing open lines of communication. This includes publicizing your open door policy through meetings, email, bulletin boards, brochures, etc. Also, you must assign specialized staff to investigate reported issues, and to talk to your team, without retaliation. To see various reporting mechanisms, click Compliance Tips & Resources in the bio/about link! P.S. Don’t forget to hit the save button, tag a colleague, book a free appointment, or grab our compliance kit (see bio/about)! Our 2019 motto: It’s time to enact!

Tip: Respond appropriately to detected offenses and develop corrective action plans within your practice. As discussed in our previous tip, we shared the 7 Elements of an Effective Compliance Program. Our focus has shifted to the fifth element, which is responding appropriately to detected offenses and developing corrective action plans are critical. When a compliance incident occurs, the first step is to ensure the compliance officer or designated employee(s) review the al...legation to determine whether it is a violation and/or if corrective action can be pursued. Always proceed with caution and investigate thoroughly before making any final decisions because it may be a misunderstanding due to unclear rules or guidelines. To review how to handle internal vs. external warnings, click Compliance Tips & Resources in the bio/about link! P.S. Don’t forget to hit the save button, tag a colleague, book a free appointment, or grab our compliance kit (see bio/about)! Our 2019 motto: It’s time to enact!

Tip: Conduct appropriate training and educate your entire practice regarding compliance regulations. In our last tip, we discussed the 7 Elements of an Effective Compliance Program, in which we would like to add the importance of conducting appropriate compliance training and education for all staff. As shared in our blog, just like you have protective measures in place to prevent malpractice suits, the same goes within the non-clinical setting (e.g., coding policies, waiting... room policies). You can no longer tell the government we didn’t know because they provide numerous resources to assist you. Since compliance is comprehensive, the first step is treating it like a class, just like your medical studies. Remember, all educational programs are tailored to your practice risk areas, and training is specific to specialty and size. The OIG suggests three steps to set up educational objectives. To review the educational objectives, click Compliance Tips & Resources in the bio/about link! P.S. Don’t forget to hit the save button, tag a colleague, book a free appointment, or grab our compliance kit (see bio/about)! Our 2019 motto: It’s time to enact!