Author Topic: What's in YOUR compliance plan?  (Read 1732 times)

PMRNC

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What's in YOUR compliance plan?
« on: June 13, 2013, 04:26:12 PM »
Before most of us post here there is ONE place we can find 99.9% of the answers. It' lies in the COMPLIANCE plan of either the healthcare provider or the billing company. Such questions as "my client wants to waive a copay..." or " what do I do with the secondary insurance?" and "can I bill a Medicaid patient for this service..."   those answers SHOULD lie in the compliance plan. If you are asking them here or in any other forum that should mean either 1) there is no compliance plan or 2) it's not clear in the compliance plan.   If you are a billing company acting on behalf of your client (health care provider) you NEED to get their compliance plan and you NEED to have your own compliance plan that tells  you what to do in most circumstances.  Asking here or on any other forum should be if 1 & 2 don't apply.  If you are a billing company you require your clients to have a compliance plan and you also have one, it really is that simple.


The sad thing is that most medical billing courses, associations and business opportunity vendors are NOT educating our billing companies on this and what they should have in place.  Yes, you need one.. if your vendor, billing course, or association is telling you otherwise they are lying to you. If they are not telling you at all than they are not doing due-diligence.   YOU must have a compliance plan, and your clients must have one as well. PERIOD.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Merry

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Re: What's in YOUR compliance plan?
« Reply #1 on: July 01, 2013, 08:41:17 PM »
Oh oh..I am seeing lots of looksies..and no one posting. This is a very HOT topic and needs to be taken so seriously. One of the most important things that a billing service must do..YOU MUST have a compliance plan.

Christy

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Re: What's in YOUR compliance plan?
« Reply #2 on: July 24, 2013, 12:46:47 PM »
just curious-how many pages are people's compliance plans?

PMRNC

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Re: What's in YOUR compliance plan?
« Reply #3 on: July 24, 2013, 02:09:22 PM »
Quote
just curious-how many pages are people's compliance plans?

Everyone's will vary. A compliance plan is put forth to entail the day to day compliance and operations of every billing company so it could vary greatly. I have mine in a 5'' binder with a P&P / Operations manual and I can tell you I might need another binder soon.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Christy

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Re: What's in YOUR compliance plan?
« Reply #4 on: July 24, 2013, 02:12:38 PM »
uh oh.... mine is about 2 pages, but I guess as I grow it will too! thanks ;D

PMRNC

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Re: What's in YOUR compliance plan?
« Reply #5 on: July 24, 2013, 03:20:43 PM »
What I did might be a bit anal.. but it worked for me. for about a year when I first started I kept a notebook for EACH client. Call it a diary of sorts. I kept notes on everything I did for that client.. there were questions that came up, I noted them, I made many many notes. Approximately a year later I had several notebooks per client added up. I sat down and condensed them to incorporate my compliance plan. I used the OIG 3rd party billing company compliance guidelines.   Basically your compliance plan is the first place you will go to whenever a compliance issue comes up. I consider it a road map. Anyone can create a compliance plan, that's the easy part.. the hard part is actually BEING compliant according to the compliance plan. It's sort of like a physician's office policy.. how many times do we see the question "Dr. So and so wants to waive Mrs. Smith's copay, is this ok?" only the answer lies in the physicians office policy. Same goes for a billing company's compliance plan.  example: " I believe I may have a data breach, what should I do." If that question has to be asked, then the compliance plan is MOOT.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Christy

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Re: What's in YOUR compliance plan?
« Reply #6 on: July 24, 2013, 04:40:58 PM »
good plan...I am in my first year and I  keep a notebook for each provider as well!  ;D

PMRNC

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Re: What's in YOUR compliance plan?
« Reply #7 on: July 25, 2013, 09:03:13 AM »
To this day I still do it. My husband makes fun of my box of notebooks. I went from a 1 subject per client to a 3 subject per client.. I have 2 big boxes of notebooks.. NO PHI. LOL  a lot of doodling though while on hold with the insurance carriers that's always fun.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com