Compliance: The Cornerstone of a Healthy Practice

September 1 2004 Eric Kaplan
Compliance: The Cornerstone of a Healthy Practice
September 1 2004 Eric Kaplan

T ODAY, MORE THAN ANY TIME IN OUR HISTORY, DOCTORS ARE being watched. Big Brother is watching! So many of­fices are worried about HIPAA. Yes, if you violate HIPAA, you will receive a fine. However, if you do not follow the rules of the OIG (Office of the Inspector General), you may not only be fined, you may face jail time. As a consultant who works with integrated practices, it stuns me to see how many offices have in­tegrated by themselves. They get a legal document from a friend and move forward. Then they wonder why they are on the cover of Dy­namic Chiropractic. There is no right way to do the wrong thing. Whether you are integrated or not, you must play by the same rules. These are not separate for MD's and DCs; they, like HIPAA,are for all Healthcare. If you are in practice, know the rules. If you are integrated, hire an attorney. While attorneys can help you with i the legal documents, most often I they are not familiar with billing, coding and compliance. This is why consultants are so important—not just to provide you with the rules, but to make sure your practice is compliant. It begins with knowing the rules. Code of Conduct It is the policy of all of my clients' offices to instruct and understand that all individuals associated with the prac­tice conduct themselves in an ethical manner and in conformance with all fed- eral and state laws and the policies and procedures of the em­ployer. To this end, your office's Conduct Code and Compli­ance Program are to be prepared to provide employees, as well as those with whom your office does business and the general public, with a formal statement of commitment to the rules of ethical conduct as spelled out in this Code. It is imperative that all my clients and personnel comply with the standards contained in the Code, and immediately report any alleged violations thereof to the Compliance Officer. This is where you begin. You must designate an employee to hold this title and assist in investigating any allegations of wrong­doing. It is our policy to prevent the occurrence of unethical or unlawful behavior, to halt such behavior as soon as reason­ably possible after its discovery, and to discipline personnel who violate the standards contained in the Code and the Com­pliance Program. No Code of Conduct can cover all circumstances or antici- pate every situation. Therefore, should an employee encounter a situation which is not addressed spe­cifically by this Code, he/she should apply the over­all philosophy and concepts of this Code to that particular situation, and observe the ethical standards of honorable people every­where. Ethics It is the responsibility of your office to obey the law. Personnel are encouraged to report all that they are doing to achieve their goals, to record all transactions accurately in their books and records, and to be honest and forthcoming with auditors. We require that all employees con­duct themselves in an honest and ethical manner, including honest bookkeeping, honest budget proposals, and hon­est economic evaluation of projects in all aspects of an employee's work. Conflict of Interest Your office and all employees must avoid situations in which their personal interests could conflict, or reasonably appear to conflict, with the interests of their employer. A conflict of interest could exist in any opportunity for per­sonal gain, apart from the normal com- pensation provided through employment or payment for ser­vices rendered. Dealing with Suppliers and Patients Conducting business with suppliers and referring providers may pose ethical or even legal problems. The following guide­lines are intended to help all personnel to make the proper "ethical" decisions. 1. "Kickbacks" and Rebates: Employees (or their families) may not receive personal kickbacks or rebates in exchange for the purchase or sale of goods or services at any time. "Kick­backs or rebates" can take many forms and are not limited to direct cash payments or credits. In general, if you or your fam­ily stands to gain personally through the transaction, it is pro- hibited. Such practices are not only un­ethical but are, in many cases, illegal. 2. Gifts or Gratuities: Employees may not, under any circumstances, accept gifts of money, nor may they solicit non-mon­etary gifts, gratuities, or any other personal benefit of any kind from suppliers or patients. Employees may accept unsolicited, non- monetary gifts from a firm or in­dividual doing, or seeking to do, business with you only if the gift is of nominal value, or the gift is primarily of an advertising/pro­motional nature. 3. Entertainment: Personnel may not encourage or solicit en­tertainment from any individual with whom your office or em­ployees do business. From time to time, employees may offer or accept entertainment, but only if the entertainment is reason­able, occurs infrequently, and does not involve lavish expendi­tures. Overcharging Insurers and patients shall not be charged for more expensive services or equipment than that actually provided. Examples of overcharging include: )* Billing for more complex or sophis­ticated (and thus more expensive) services or equipment than actu­ally provided (up-coding); y Billing two insurers, such as Medi­care and a private insurer, for the same services or equipment; and ^Waiving a patient's co-payment without informing the government so that the government believes that your charges are higher than they actually are. Books and Records Falsification of Records: Federal law requires us to ensure that our books and records accurately reflect the true na­ture of the transactions represented. It is against our policy for any employee to cause our books and records to be inaccurate. This is why we like ink, ver­sus pencil. Examples of false or artificial record entries include the following: Making the records appear as though medical services or equip­ ment were provided to a patient when, in fact, no such equipment or service was ever provided to that patient; Making the records appear as though one type of medical service or equipment was provided to a patient when, in fact, a differ­ent type of medical service or equipment was pro- vided to the patient; • Making the records appear as though a medical service or equipment was provided to one person when, in fact, it was provided to another; Making the records appear as though a medical service or equipment was provided to a patient on a certain date when, in fact, the ser­vice or equipment actually was pro­vided on a later date; and • The creation of any other records that do not reflect the true nature of the transaction. Any employee who knows, or should know, that he or she is making false or artificial record entries shall be sub­ject to disciplinary action, including possible termination. Employee Relations It is the responsibility of your office to provide equal em­ployment opportunities to individuals who are qualified to per­form job requirements, regardless of their race, color, sex, reli­gion, national origin or age. There are laws that prohibit dis­crimination against minorities, sexual harassment, and similar misconduct. Regardless of any legal prohibition, every ► ► employee has a right to work in an environment free of harassment or dis­crimination based upon sex, race, creed, physical condition or national origin. All employees shall treat each other with courtesy and fairness and have respect for the dignity of others. Reports of Wrongdoing Each employee has a duty to report any suspected violation of your office's Code of Conduct. If any employee reasonably suspects that any employee, subcontrac­tor or agent is involved in any sort of criminal wrongdoing, or has or is violat­ing the guidelines or policies contained in the Code, that employee should imme­diately report those suspicions directly to the Compliance Officer. In the event that an employee feels that a report has been given inadequate attention by the Compliance Officer, the employee may re­port to the Clinic Owner or Administra­tor. Remember this rule: REPORTS OF VIO­LATIONS BY EMPLOYEES MAY BE MADE WITHOUT FEAR OF RETALIA­TION. This is a mandatory component. If you would like more information, go online to Office of the Inspector General. The world of healthcare and compli­ance is based on results! Dr. Eric S. Kaplan is CEO of Mutt {disciplinary Business Appli­cations. Inc. (MBA), a comprehen­sive coaching firm with a success­ful, documented histoiy of creating profitable multidisciplinary prac­tices nationwide. For more infor­mation, call (561) 626-3004. DR. ERIC S. KAPLAN NOTE: Be sure to check the Upcoming Seminar Section (pg. 56) for more information on a great chance to DO THE RIGHT THING! For a limited time, register to win FREE tickets at www.lpgone.com, courtesy of LPG, our Title Sponsors. UPDATE: The Expansion of Chiropractic to Russia The first Chiropractic to Russia to Russia Summit was held August 28,2004 in Houston, Texas. There were doctors and interested parties who attended from all over the country as well as from Canada. ■ Currently steps are being taken to establish a Chiropractic program and College in Russia as well as helping establish clinics there to begin helping the citizens of that country have the opportunity for a healthier lifestyle. The goal of the meeting was to assign steps that are required to create this amazing endeavor. Progress is being made to help expand chiropractic in Russia and steps are being taken to create the chiropractic college for enrollment of Russian citizens. There was an initial trip in June of 2004 to Moscow and St. Petersburg and three more working trips are scheduled to Russia in September, December and February. This project will require a lot of help and as many "connections" as possible. If you, or anyone you may know, are at all interested in working or contributing in any way on this exciting project to please contact Dr. Sherry Durrett at [email protected] or by phone at 281-444-1000. BAILEY'S Model 486: Back Extension Treatment Table This specially equipped table is designed with the busy McKenzie Method practitioner in mind. Narrow width and Face Slot eases manual low back therapy procedures. The Pelvic Strap is fully adjustable to stabilize patients of every stature. The generously rounded corners and 1" thick top ensure the comfort of both therapist and patient! Back Extension Table Features: 24"W x 30"H x 78"L; optional sizes available. 1" thick top, vinyl upholstery in US 387 Camel, standard. Choice of optional Bailey upholstery colors, and either Natural or Dark Walnut wood finishes. Fully adjustable Pelvic Strap; Full Storage Shelf. Infinitely Adjustable Gas Spring Back with face slot. Weight capacity 350 Ib. Ship weight 1401b. For more information, see full catalog of products at www.baileymfg.com or call 1 -800-321 -8372. front row L to R: Dr. Assiat Boke MN, Native Russian, Wendy Lieberman MN, Christina Alexander TX, Dr. Chad Cohoon KS, Joan Spry R.N. TX, back row L to R: Dr. Arlen Lieberman MN, Larry Berg IL, Dr. Michel Tetrault Canada, Dr. Doug Howard UT, Tami Denton TX. Dr. David Howard CA, Dr. Richard Parliman TX, Dr. Sherry Durrett TX. Back Extension Treatment Table [Shown in EX 254 Saddle]