How to Start a Medical Billing Compliance Program
Accuracy is paramount in the medical billing industry. Because many payors have specific guidelines for claim submittal, it's vital to implement and maintain a detailed billing compliance program.
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Instructions
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Assign a compliance monitor to ensure that the organization is compliant. The individual(s) selected for this role will be required to educate, enforce discipline, access and review records, and conduct periodic quality and assurance audits.
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Determine what the federal, state and company guideline requirements are. Decide which guidelines will take precedence when there are differences. Establish the compliance program's implementation procedures once guidelines are established.
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Build a relationship with department heads to ensure that the importance of compliance is communicated throughout the organization. Ensure that each department is aware of and practicing compliance.
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Establish formal protocols in writing for everything, from codes of conduct to policies and procedures. Have these documents available to all members of the organization. Senior management and the organization's board need to approve and sign off on these documents.
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Provide compliance training for all employees as part of their initial employment orientation and regularly following the hire date. Compliance officers must have employees sign sheets of attendance for each instance of formal compliance training. If the course is taken electronically, it must be tracked via a computer application.
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Implement methods to address compliance violations as well as prevent them. Depending on the level of the violation, laws may have been broken and correct protocol must be followed and appropriate action taken.
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Complete bill submission electronically as much as possible. Use software to scrub the claims to ensure that the billing information is accurate and nothing is omitted.
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Tips & Warnings
Establish a relationship with the payors' ombudsman or representative. This will enable you to have a direct contact with the payors to be informed as changes arise.
Provide multiple formats to report compliance violations, such as a 24-hour telephone hotline or emails directly to the compliance officer. Employees need to feel that there won't be retribution or retaliation should they report compliance violations or breaches.
The information captured when the patient is treated initially may dictate to some level how compliant the billing is. It's imperative that the intake information is accurate.
