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Compliance Program Development - Part II

Medicare (CMS) Fraud & Abuse Compliance

The OIG guidelines for compliance programs for solo and small group practices released in 2000 send a clear message that the federal government expects physician practices of all sizes to have active Medicare compliance plans in place. The guidelines address four general areas of risk for medical practices: (1) coding and billing, (2) reasonable and necessary services, (3) chart documentation, and (4) improper inducements, kickbacks, and self-referrals.

For your compliance program to be "deemed effective" by the OIG, it must include the following seven core elements:

  1. Implementation of written policies and standards of conduct for office staff;
  2. Designation of a compliance officer or contact;
  3. Development of training and education programs for office staff;
  4. Creation of accessible lines of communication to keep practice employees updated about compliance activities;
  5. Performance of internal audits to monitor compliance;
  6. Enforcement of standards through well-publicized disciplinary directives; and
  7. Prompt corrective action when offenses are detected.

Simply having a written plan will not, however, satisfy the OIG requirement that a compliance program be "operationally effective" and that it become "part of the fabric of the practice." There is no "one-size-fits-all" compliance program for physician practices as the applicability of the OIG's recommendations will depend on the circumstances of each particular practice. If your compliance plan is ill-suited to your practice and is therefore not able to be fully implemented and followed, your efforts may be perceived by government enforcers (in the event of an audit) as "window dressing" and a sign of a cavalier attitude about compliance. For a compliance program to serve its intended purposes, it must be designed to fit the characteristics and capabilities of the practice, no matter how large or small.

Marc H. Bailey & Associates will assist your practice in structuring and implementing a practical, workable Medicare compliance plan tailored to fit the unique needs and capabilities of your practice. Your plan will set achievable goals within appropriate timeframes given the resources available to your compliance effort and the competing demands on the individuals responsible for making your compliance plan work. Additionally, your plan will provide tangible benefits with the least amount of disruption to your office routines.

Some of the benefits realized by medical practices as a result of implementing compliance plans include:

  • Improved medical record documentation;
  • Improved education for practice employees;
  • Reduction of claim denials;
  • More streamlined practice operations and workflow through better communication and more comprehensive policies/procedures.
  • Avoidance of potential liability arising out of noncompliance and reduced exposure to potential federal penalties.

OSHA Compliance

Beyond OSHA's primary goal of creating a safer work environment, there's another good reason to insure your office is in compliance with OSHA requirements. OSHA complaints are on the rise in medical practices as employees are becoming more aware of the law and of their rights as employees. Inspection data from California shows that the state's OSHA agency (Cal-OSHA) conducted 36 inspections of physician offices in 2004 resulting in 99 citations. Of the 36 inspections, 33 were conducted in response to complaints from either employees or patients.

The following OSHA standards apply to all physician offices, regardless of size:

  1. Bloodborne Pathogens - regulations designed to reduce occupational exposure to bloodborne diseases (HIV, hepatitis B and hepatitis C viruses) and include the following basic requirements:
    • A written exposure control plan, updated annually
    • Use of safer, engineered needles and sharps
    • Use of proper protective equipment (gloves, eye protection, gowns, etc.)
    • Use of universal precautions
    • No-cost hepatitis B vaccines to exposed staff
    • Medical follow-up after an exposure incident
    • Proper containment and identification of all regulated wastes
    • Employee training
  2. Hazard Communication - requires a written list of all hazardous chemicals of any kind used in the office (e.g., alcohol, disinfectants, sterilants, etc.). For each listed hazardous chemical, your employees must have access to the Material Safety Data Sheet (supplied by the manufacturer) which outlines the proper procedures for working with the specific substance.
  3. Exit Routes - requires all medical practices to establish and post exit routes in the office for the emergency evacuation of patients and employees.
  4. Electrical - requires the safe use and location of both office and medical equipment.
  5. Reporting Occupational Injuries and Illnesses - requires the maintenance of a log to record employee injuries and illnesses. (Medical practices are currently exempt from this requirement under federal law but many states have their own OSHA programs which may include this requirement.)
  6. OSHA Poster - requires every practice to display the Notice of Employee Rights poster in a conspicuous place.
  7. Ionizing Radiation - requires those practices that offer x-ray and related imaging services to:
    • Designate restricted areas to limit employee exposure
    • Supply personal radiation monitors to employees working in restricted areas
    • Label rooms and equipment, as needed, with caution signs.

Marc H. Bailey & Associates will assist your practice in meeting all OSHA requirements, to include: preparation of an OSHA Manual tailored to your practice needs and specific to California OSHA law, a comprehensive inspection of your office including review and organization of your past OSHA records if necessary, labeling of secondary containers with approved NFPA labels, posting all required plastic signs and OSHA posters, preparation of a custom MSDS Manual, preparation of a Records Manual with required forms, and presentation of a 2 hour in-house OSHA training seminar for your employees (if requested).

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Marc H. Bailey and Associates • 5013 Butterfield Court • Culver City, CA 90230 • Tel. 310.838.9170 •