I’m Sick and Damn Tired of Compliance, and I’m Not Going to Do It Anymore!
FEATURE
DOCUMENTATION
Ray Foxworth
DC, FICC, MCS-P
For years, we have seen headlines and heard consultants stress the importance of having compliance programs in our offices. We can buy readymade manuals, customized manuals, attend webinars/seminars on how to be compliant, but many of us don’t know what it means to run a compliant office. The reality is that, yes, we need a manual, but it’s not just enough to put it on the shelf and call it a day. Compliance is an ongoing process for your practice. Having a manual but not updating it on a frequent basis is worse than not having one at all.
The problem isn’t that we don’t want to be compliant, preventing us from implementing successful programs in our offices. It’s a lack of clear-cut direction, time, and money. So, what does it take to have a compliance program in your office? The OIG laid out the seven fundamental elements of an effective compliance program.
1. Implementing written policies, procedures, and standards of conduct.
You and your entire team need to understand the regulatory standards from the OCR (Office of Civil Rights), OSHA, HIPAA, Medicare/Medicaid, etc. with which you need to comply. Establishing written policies and procedures that support those standards within your practice helps your team remain compliant while carrying out their job functions.
2. Designating a compliance officer.
The compliance officer can be you, any member of your team, or you can outsource compliance to an outside company. When choosing a compliance officer, be mindful that this person should have sufficient training, authority, time, and autonomy to carry out his or her responsibilities. For those who read news feeds on mobile devices, look up Walgreens. Just yesterday, they agreed to a multimilliondollar settlement with the government, partly for charging more to Medicaid than they did to others. Yes, Part D providers do have different rules than Part B. However, the real takeaway is that you would think that a company as large as Walgreens, with their layers of compliance staff and attorneys, wouldn’t end up in this situation. They did, though, and it should give us pause and force the question, “Do I really want to deal with this or is my office better off focusing on patients and generating revenue, rather than going back to school to learn compliance?”
3. Conducting effective training and education.
Understanding the policies and procedures in your practice is a must. Failure to train your team exposes your practice to risk. Training needs to be recorded in your compliance manual and scheduled regularly.
4. Developing effective lines of communication.
Compliance is serious and should be taken seriously by every employee. You need to establish a culture of compliance within your practice and open the lines of communication between you and your staff.
5. Conducting internal monitoring and auditing.
Monitoring and auditing in your practice will let you know your areas of risk and allow you to establish procedures to minimize those risks. Additionally, it helps you avoid submitting incorrect claims to payers. Assessments should be performed on billing systems, claims accuracy, coding accuracy, and documentation standards.
6. Enforcing standards through well-publicized disciplinary guidelines.
Establishing disciplinary guidelines for conduct and actions that violate the policies, procedures, and standards of conduct in your practice lets your team know that compliance is a priority and everyone’s responsibility.
7. Responding promptly to detected offenses and undertaking corrective action.
It is easy to be bogged down in the day-to-day responsibilities in practice, but not taking immediate action when detected offenses arise is bad business. Your goal is to respond quickly and efficiently when issues emerge and establish a corrective action plan to prevent further errors.
Many providers who have successfully implemented compliance programs in their offices have found that they become more profitable. The risks that expose us to high fines and penalties are also the ones that cause us to lose money without even realizing it. Does it take time and knowledge in these critical areas of compliance to establish a compliance program in your office? Yes, but the cost of not being compliant is much higher. For almost a decade, we have heard that audits are on the rise, but what does that mean? Who is being audited? Who is doing the auditing? The answers might surprise you.
I hear from providers every week who say that they are no longer going to see Medicare patients because the potential for audits that result in devastating fines and penalties is just too risky. However, one consultant who was hired to assist chiropractors in over 500 audits said that Medicare wasn’t the primary initiate in the cases he consulted (24%). Most audits were the result of records requests from BCBS, UHC, Cigna, and Aetna (67%). Records requests are a part of regular, everyday practice. In fact, no one in my office seems anxious when we receive one. Often, it’s viewed as “something else to do” on their already overloaded to-do lists and nothing more. However, they should be concerned. According to that same consultant, the fines and penalties resulting from these audits were, in some cases, financially devastating to the practices.
According to Steve Conway, DC, JD, one of the most challenging aspects of defending a chiropractor in an audit is that most of them were unaware they had a compliance issue of such a high magnitude. In most cases, it is only upon receiving an audit letter that the importance of compliance became clear. Aside from the financial burden, the emotional hardship takes its toll. “My clients embark on an emotional roller coaster of fear, denial, anger, and despair that ultimately leads to loss of sleep, decreased production at the office, and, many times, drives them to make fearbased decisions.”
Maintaining a compliance program in my office was a chore. Our compliance officer was not just a compliance officer, but also a chiropractor. It didn’t take long for me to realize that the time, effort, and energy she spent not directly related to patient care cost my practice money. I went through an exercise to determine the net revenue per hour* that my office generates. Completing this exercise allowed me to see that my doctors and staff could produce $249 per hour. Any time spent in my office not focused on tasks that generate revenue (patient care, etc.) is not the best use of our time. Estimating that she was spending one hour per day (20 hours per month) on our compliance program, the cost to our practice was close to $5,000 per month, or $60,000 per year. This realization led me to look at other options for my office. That’s when I hired a third party, with a team of people trained and certified to manage our compliance program, at a fraction of the cost to do it myself. They handle the assessments, reviews, reports, and all of our compliance needs.
I am a DIY guy at heart and going through the process of establishing a compliance program in my office taught my compliance officer and me a valuable lesson. We don’t want to be responsible for all of this. Having someone else take responsibility for our compliance program took away the stress for both of us and allowed her to do what she does best—treat patients. That was when I realized that compliance doesn’t have to be hard, it doesn’t have to be time-consuming, and we don’t have to do it all on our own.
Want to calculate your net revenue per hour, email [email protected] and put “Net Revenue Calculator” in the subject line.
Dr. Ray Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA.
A practicing Chiropractor, he remains "in the trenches" facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center, and is a Fellow of the International College of Chiropractic. To request a free one-page financial policy, send an email to [email protected].
