Why is a Compliance Plan Crucial?

The pandemic has exposed healthcare to new perils, requiring most practices and hospitals to update and revamp their policies. To ensure a seamless deliverance of patient care, clinics and hospitals should ensure that its legal system is in place in order to provide protection against any harmful legalities and for guaranteeing that the staff and patients are protected and have a clear understanding of all OSHA and HIPAA compliance procedures. All healthcare organizations should have an iron clad compliance plan that explicitly outlines policies, and procedures pertinent to billing, coding, management, and reimbursement.

What is a compliance plan?

A Medical practice, like its corporate counterparts, operates in accordance with the legal and ethical framework predetermined by regulatory authorities. A compliance plan is a set of procedures developed to allow continuous adherence of staff and patients to ethical, legal, and professional policies first developed in 1918 by the American College of Surgeons. The main motivation behind the formulation of a compliance plan is to improve patient care in the long run and to pave the path for professional development.

This plan is a means by which regulatory authorities and the government can oversee your clinic or hospital’s performance over a period. The plan encompasses the following areas of medical practice:

• HIPAA
• Billing
• Coding
• Patient management
• OSHA
• Research

What are the constituents of a compliance plan?

As stated earlier, the plan is holistic in the sense that it takes into account all facets of medical practice. The main aim behind planning healthcare compliance is to ensure that the policies in your practice are coherent with state and federal law. The Office of Inspector General (OIG) and healthcare will detail objectives and scope of work to be performed to assess appropriate evidence against criteria that should be in place. Your compliance plan should have the following seven components:

1. Hard copies of compliance plan distributed amongst the staff

   The first recipients and disciples of any healthcare compliance plan are the employers of medical practice. Regulatory authorities understand that the plans are available online and that most of your employees have an internet connection, but they will question you about your role in educating the staff about the tenets of the code of conduct and the law. Therefore, it is important that the compliance plan is printed or handwritten, with every new and old employee having a copy that they can refer to whenever the need arises.

2. Expert to supervise

   Doctors and other healthcare staff are not expected to know compliance well enough to integrate them into daily practice. A compliance officer is a certified expert who has the knowledge and knack needed to implement the plan as properly as possible to avoid regulatory scrutiny.

3. Dedicated professional training

   Printing and circulating a healthcare compliance plan amongst your employees is not enough. To help them comprehend the policies and procedures thoroughly, regular compliance workshops need to be conducted.

4. Proper communication

   The best way to avoid compliance issues is to address them before they grow. Any non-compliance should be reported immediately before the smoke reaches the authorities, forcing them to shut down the practice. Patients and staff alike should be equipped with conduits via which they can communicate compliance problems easily. The same should apply to the timing and quality of a response to the complaint registered.

5. Internal auditing and accountability

   The in-house compliance officer should be directed to run an internal monitoring program to check the compliance quality and sufficiency so that any problem can be addressed before the authorities hear about it.

Not having a compliance plan could cause your facility or organization unwanted penalties, a compliance plan will ensure that every task undertaken at your medical practice is coherent with the law. The plan also sets up certain standards of practice to bring uniformity of operation and avoid malpractice lawsuits or unpaid reimbursements. It is important to plan and have a written and announced compliance plan. It is important for a practice or hospital to adhere to safe and quality of care that can be delivered to their patients because billing, coding, and reimbursement are organized and outlined in the plan.

PETTIGREW has a complete compliance plan that includes: