COMPLIANCE & HIPAA
By far the fastest growing and most confusing area of practice management is compliance. So many entities seem to have a stake in the game. The federal government is perpetually trying to ferret out fraud and abuse; state governments are struggling to manage Medicaid budgets, commercial payors to take advantage of the tools given them by HIPAA and increasingly educated patients are questioning the legitimacy of charges with impunity. Conventional wisdom suggests that all practices must have a plan, regular educational sessions, be able to identify variances and outliers and an appropriate means of enforcement.
The problem is that most compliance policies are written in vague and non-specific terms. The trick is to know the intent and spirit of the guidelines and apply the general to the specific clinical situations. It is not always clear what position or standard to believe. As is true of so many aspects of the law, precedent can be determinant. Knowing which sources to trust and what guidelines to accept requires a detailed and comprehensive understanding of government policies, audit patterns and trends and payor practices.
Because ABC only manages anesthesia and pain management practices its compliance staff and auditors are perpetually monitoring the state of compliance. Our staff communicates on a regular basis with those who write Medicare policy in Baltimore, those who are responsible for claims adjudication and legal precedents. The result has been an unblemished record of keeping ABC clients off auditor radar screens. Our approach and plan is the best strategy an anesthesia group can adopt to stay compliant.
It should go without saying that this is an increasingly important part of the effective management of a practice today. However important AR management and revenue enhancement, there is nothing more painful than having to give back money due to inadequate documentation or overly aggressive charge structures.
