Compliance is vital for healthcare practices, since trouble could be brewing just around the corner. Compliance is ensured by medical outsourcing services.

1. Compliance Program Essential for Medical
Practices and Facilities
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2. Why Is a Compliance Program Important?
You need to get your coding, documentation, productivity stats and revenue
integrity all monitored. Thanks to the availability of advanced data analytics, non-
compliant physician profiles can be identified easily. Without a serious compliance
program in place, False Claims Act liability and increased scrutiny of your practice
for law enforcement are all possibilities. It is scary but essential to note that in the
first half of 2014, federal audit recoveries amounted to $3.1 billion, the result of
false healthcare program claims. This shows that regulatory compliance is
important even if it saps resources.
Providers of medical outsourcing services are careful to ensure regulatory
compliance. That is why outsourcing labor and time intensive processes such as
medical billing and coding often proves to be more efficient and cost-effective than
performing these in-house.
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3. Important Aspects of Compliance
Here are some of the aspects that need to be incorporated for an effective
compliance program. These can be carried out in-house or through the outsourced
medical services of a medical billing and coding company.
The compliance guidance plan of the Office of Inspector General contains
some vital elements that must be implemented.
It is important to carry out regular audits involving assessment of
risks. This can help identify areas to work on with high risk and enable
them to be addressed first. Benchmark audits can help review small data
samples and also help set up a baseline for future audits. In instances
where benchmark audits reveal issues, an expanded audit plan may be
required. Corrective action must be implemented after the problem is
identified, and it must be followed up on. Monitoring and auditing must be
a continuous process.
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4.  Payment errors must be reported, particularly payments that were not entitled to
come to your practice. The CMS is very firm regarding this and has revealed the
requirements for self-disclosure.
Payment errors must be reported, particularly payments that were not
entitled to come to your practice. The CMS is very firm regarding this and
has revealed the requirements for self-disclosure.
The Affordable Care Act requires providers as well as suppliers to set up a
compliance program containing some primary elements required for
enrollment in Medicaid and Medicare as well as CHIP. Medicaid providers
meeting some of the criteria are mandated certain compliance certification
requirements in Arkansas and New York State.
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5. You may need to hire a staff member or an outsourcing partner for
efficiently leading your practice’s compliance program. Regular self-audits
and risk adjustments need to be performed so that potential issues can be
promptly identified and rectified. Issues are bound to be there in any
healthcare practice.
Finally it is important for the staff of your practice to be trained in
identifying and reporting abuse and fraud, if you are handling compliance
in-house. The importance of compliance must be understood by every
staff member. Training must also be provided in ensuring revenue
integrity and avoiding errors.
With medical outsourcing services providing dedicated compliance solutions, it
becomes easier for healthcare practices to focus on their core functions and stay
clear of penalties.
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6. About Outsource Strategies International
Outsource Strategies International (OSI) is a reputable medical outsourcing
solutions provider based in Tulsa, Oklahoma offering advanced medical billing
and coding solutions for hospitals, physicians, physicians' groups, clinics and
other healthcare entities. Find more details at: www.outsourcestrategies.com
Contact Us
8596 E. 101st Street, Suite H
Tulsa, OK 74133
Main: (800) 670 2809
Fax: (877) 835-5442
E-mail: info@managedoutsource.com
URL: www.outsourcestrategies.com