Why Develop a Compliance Program?
The Office of Inspector General (OIG) found errors in thirty percent (30%) of all 1996 claims paid by the Health Care Financing Administration (HCFA). Errors ranged from inadvertent mistakes to what was determined to be outright fraud and abuse. Rooting out fraud and abuse has become a high priority of the Clinton administration as a means of decreasing Medicare costs and the budget. To aid in the close scrutiny of health care institutions, significant dollars have been made available to investigators and prosecutors through the Health Insurance Portability Act of 1996, signed by the president in August of 1996. As HCFA has reported a $23 recoup for every dollar spent on investigations, it is unlikely that we will see anything but increase in audit activities. Providers who, upon review, are not found to be in compliance with fraud and abuse laws have often been required to implement a comprehensive compliance program to monitor and remedy faulty billing practices. However, under the Sentencing Guidelines, institutions who have implemented an "effective program to prevent and detect violations of the law" are treated more favorably than those without any program. Are Compliance Programs Necessary for Small Organizations? Just read the latest headlines: Medical Suppliers, Hospitals and Physicians have been forced to pay millions of dollars in fines and settlements as a result of the recent "compliance crackdown." Were these institutions guilty or innocent? Or were they just honest mistakes in coding, documentation and everyday billing errors that just ended up under review at the OIG? It's unfortunate for today's healthcare providers, but the look of guilt is all that is needed to get you smack in the middle of a federal investigation. Given
the large penalties that have been accessed, the benefits of a compliance program for
large organizations is obvious. But, what about smaller organizations? We
believe that no matter what the size of the organization you are not beyond
reprieve. MedNet's compliance program assures you that your organizations
billing department is fully compliant with federal billing requirements and regulations.
Don't leave anything to chance! By
choosing MedNet as your management company, our compliance program becomes your compliance
program. We've designed our compliance program to meet the stringent needs placed on you
by governmental and insurance agencies. Protect yourself and the business you have worked
so hard to build. MedNet CCP -- Works For You! Medical Billing is incredibly more complex, more exact and more intense than it has ever been. The frequency of audits by the government and insurance agencies has markedly raised the level of accountability and the risk of major fines and recoupments no matter what the size of your organization. Medical Billing is no longer a simple office task that can be delegated to just anyone, it is now a profession that requires trained professionals that receive ongoing education keeping them up to date with the constantly changing regulations. |
MedNet, Inc. Phone: 314.426.7778 or 800.840.9966
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