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April 4, 2012
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It's time to pay attention to "Compliance"
C ompliance, on the whole, is largely ignored by most smaller medical practices. Over the next few issues of the PBN Minute we'll take a look at topics including . . .
What is "Compliance?" We'll briefly review compliance laws and regulations as they apply to the general industry plus take a look at which laws apply specifically to healthcare.
The History of Compliance in the Healthcare Industry. Though healthcare compliance laws may be new to you and your practice, they've actually been around for many years. What's new is that the Affordable Care Act (ACA) requires "all sectors of the health care industry " to develop an effective compliance program. We will review the 15 year history of compliance laws and summarize how they've changed and which ones apply now.
Compliance laws and guidance and how they apply to your organization or practice. The Office of the Inspector General (OIG) created both the voluntary program guidance and the original laws requiring compliance programs. Nowadays (with a possible caveat--see Jud's sidebar) we also have to pay attention to requirements and guidance from the CMS (Centers for Medicare and Medicaid Services) CPI (Center for Program Integrity). We'll compare the various requirements and suggest ways they can fit within your existing quality initiatives and planning.
How do you know you're in compliance with healthcare compliance regulations? This topic will include practical advice for developing an "effective" compliance program, where you can get free and fee-based help, and a list of steps you have to do yourself.
The future of compliance. If the ACA is ruled unconstitutional by The Supreme Court this June and you work in a small practice setting, you might not be subject to laws requiring a compliance program. Whether or not the ACA is held up, you may be subject to other laws and regulations requiring a similar program. The final topic will cover what's likely to happen in compliance in the future and how to best plan for it.
To find out how PBN can help your organization or practice with compliance requirements, contact . . .
PBN Business Development, 800.288.4901 or
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Inside the
Meanwhile . . . We stand on the brink of the end of the ACA . . . or maybe not.
How sweeping would the end of ACA be? For one thing, this month's PBN Minute topic will be moot for smaller practices (the ACA includes the provision that makes compliance plans mandatory for all medical practices). Then, the benefits promised to help many millions of people would be taken away, in the interim at least. Or, if people who would like to see the law repealed altogether are right, business will benefit from less burdensome regulation.
Beyond that, if the ACA is deemed unconstitutional (and the entire law is thrown out because of its lack of a "severability" clause), what happens to the state and federal funds already spent to pay to set up insurance exchanges and put other parts of the act into action?
Will we revert to the previous laws and health care premium increases of 9% per year or more? It seems unlikely that there is time or the political will to create and pass new healthcare reform measures in an election year.
A more likely scenario: the individual mandate is found unconstitutional. The parts of the existing law that depend on the mandate are dismantled individually and replaced by new provisions. The reality is that we're probably too far down the road to afford the costs and complications associated with walking all the way back to square one . . .
What's a practice to do?
Give me a call to find out how we can help.
— Jud
Jud Neal, PBN President & CEO
Visit us online at PBNMed.com .
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