PBN Minute - Up to the minute information for your financial success

	Up to the minute information for your financial success.	August 13, 2012 To ensure you receive future Minutes, click this link . *To ensure you don't, click here to opt out .*
	It's time to pay attention to "Compliance" Some Practical Advice, Free and Otherwise. How do you know whether your organization is in line with current healthcare compliance regulations? First, of course, you need to know exactly what applies to you. Check out the first PBN Minute in this series for some guidance and links to related information, or go the OIG's "Compliance 101" website where you'll find a wealth of materials to help you get started. The "Compliance Guidance" page is a good place to start. Here you'll find separate guidance documents for each of the groups covered under healthcare compliance. 2-7-8 Once you've reviewed the compliance guidance documents, you'll see that all of the guidelines have several things in common . . . they are all based on two fundamental goals and a set of seven requirements. These were all originally published in "Chapter 8: Sentencing of Organizations" in the U. S. Sentencing Commission's Sentencing Guidelines Manual . Two Fundamental Goals The two fundamental goals required in your compliance program make it clear that you must go beyond simply showing that your organization understands which laws apply directly to you. You must also show specifically how your organization "effectively" . . . exercise(s) due diligence to prevent and detect criminal conduct; and promote(s) an organizational culture that encourages ethical conduct and a commitment to compliance with the law. (A Third Goal) There's also a third goal--reduce your corporate liability. In plain language, the regulations explain that if someone in your organization violates a law that puts your organization at risk of legal action, having a clearly documented, implemented and promoted compliance program in place will significantly reduce your corporate culpability. For example, the sentencing guidelines call for reducing your "culpability score" by as much as three points (a 60% reduction) if you can show that you had an effective plan in place. Plus, under the federal guidelines for fines (§8C2.5(f)), having an "effective" compliance program may legally distance your organization from the individual who violated the regulation and reduce or even eliminate any fines assessed against your organization. Seven Requirements The text of the actual seven requirements is listed under §8B2.1.(b) of the sentencing guidelines (follow the link to review them in their entirety), but essentially they mean: You are required to develop and implement a compliance program. You can't just delegate the program to an administrator or third party. Your organization's "governing authority" has to be "knowledgeable" about the program. You must exclude known prior law-breakers (or ones you should have known about) and scoff-laws. You must communicate with, train and keep informed everybody in your organization about the program. You must police your own organization, including "monitoring and auditing to detect criminal conduct," and have a system in place that allows whistleblowers to blow the whistle "without fear of retaliation." You must use a carrot-and-stick approach that rewards compliance and punishes non-compliance in the program. In the event of misconduct, you must "respond appropriately" which includes taking steps to prevent future misconduct. Following the two fundamental goals and seven requirements when you develop your program provides a roadmap for due diligence (along with the published guidelines mentioned earlier). The rest is about making your program specific to your organization and its practices. Getting Help . . . Ultimately, the law requires that you implement and monitor your own program. But it also encourages (especially for smaller physician groups) getting started by adopting already developed and "effective" programs, then modifying them to fit your organization. . . . PBN is here to help. If you have compliance questions or needs, contact PBN Business Development, 800.288.4901 or . ^{< sup>}^{^[1] These currently include nursing facilities, medical research award recipients, hospitals, pharma manufacturers, ambulance suppliers, individual and small group physician practices, nursing facilities, Medicare+choice organizations, hospices, the durable medical equipment prosthetics, orthotics, and supply Industry, third-party medical billers, clinical labs, home health agencies, and hospitals.} All content © 2012 Physicians Business Network \| 8900 Indian Creek Parkway, Suite 500 Overland Park, KS 66210 \| 800.288.4901 \| pbnmed.com Opt-in to subscribe. \| Opt-out to unsubscribe.	Inside the Sit back, here comes the drill . . . With the Supreme Court's decision to uphold the ACA (minus requiring states to opt-in for increases in Medicaid or lose their current funding), many, many articles were published over the last few weeks offering up opinions about what exactly that may mean for physicians and other healthcare providers. Mainly, opinions seem to split right along politcal lines. Whether you agree with Kenneth Davis, M.D. CEO of Mt. Sinai Medical Center that: "Healthcare in this country should be a right, not a privilege. And the Supreme Court upholding this law goes far toward making that a reality." . . . or believe along with Congressman Phil Gingrey, M.D. that : " . . . this disappointing ruling will be disastrous for our health care system, patients, and physicians." . . . moving forward with healthcare reform as envisioned by the act (barring a political miracle) now looks inevitable. What's a practice to do? For one thing, you can stay informed. I hope PBN and "The PBN Minute" help in that regard. Call us if you'd like to know more about how we can help. — Jud Jud Neal, PBN President & CEO Visit us online at PBNMed.com .

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