The Fundamentals of an Effective Compliance Plan

When creating a compliance plan, there are a lot of things to keep in mind, especially in the health care business. Your compliance plan is essentially your safety net to make sure that everything is done correctly, there's proper oversight, and that every record is processed through a set series of steps to make sure their privacy is respected and they are billed for the proper services.

Not having a strong compliance plan can lead to a lot of problems, namely fines and unhappy patients when they are billed for incorrect services or their personal or medical information is disclosed to entities who have no right to that information. Here are some of the most important fundamentals to form an effective compliance plan.

1. Make It Consistent

When it comes to following step by step instructions, nothing is more confusing than having a million different steps that change on a case to case basis. When setting up your compliance plan, make sure that if you have different ways of processing financials, there are separate protocols for each scenario from start to finish.

For example, this could be patients with private insurance, patients with Medicaid or Medicare, and customers who pay out of pocket. Even if a lot of the process for each is similar, it is a lot easier for people to simply follow a list from start to finish than to use critical thinking skills to determine what branching path of protocols they need to take.

2. Implement Oversight

Oversight is very important when it comes to making a compliance plan. There needs to be some form of accountability as well as someone who oversees how records are being processed. Appointing a compliance officer to handle these things is highly recommended.

Your compliance officer should know the system in and out, and be able to effectively train new employees on the subject of how to follow protocols. They should also audit records and hold regular reviews of files to ensure that your employees are adhering to protocols and take measures to help iron out any problems that arise, either through retraining employees, making changes to outdated protocols, etc.

3. Use Billing Software

With the rise in technology, billing software and system databases have become increasingly popular among businesses. They can help reduce the risk of information leaks, breaches of privacy, as well as help you adhere to your compliance plan.

This software keeps all of your patient records together, including treatment sessions, insurance information, and any updates and changes to treatments. This helps ensure all of the related information stays together in the patient's file, lowering the risk of billing for incorrect services or for other patient's procedures.

4. Have a Lawyer Assist

Medical compliance law and the laws behind information security can be very complex. With different levels of information, including public, private, and confidential, as well as keeping track of the type of information that goes into each and who should have access to what types can get extremely overwhelming.

Because of how complex information management can get, let alone setting up a system to properly organize and distribute it all, it is highly recommended you have a lawyer assist in setting up your compliance plan, as well as keeping them on retainer for when there is a breach in compliance and you find yourself in some legal trouble.

Your compliance plan could also be primed to include backup measures in case a breach of privacy does occur through improper handling of records. If you need help with formulating a compliance plan, the lawyers at Hendershot Cowart can help draw up a plan that works best for your practice.

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