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Physician Compliance Services
Truth be told. . . physicians look upon
compliance efforts as an additional burden. But compliance is a necessary
consideration for everyone working within a health care organization. Just
look at the evening news or read the latest headlines.
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"Feds
Target Overcharging Docs"
AARP BULLETIN
"Medicare Billing Discrepancies at All Time High"
Courier Post
"Philadelphia Area Eyed in Wider Battle on Health Fraud"
Philadelphia
Inquirer
Federal Fraud
Enforcement - Physician Compliance
American Medical Association
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Compliance is most often regarded as a costly
bureaucratic burden with little or no return. JAF Consulting, Inc. has
shown on numerous occasions that compliance is provides opportunity for:
 | Revenue enhancement |
| Risk reduction |
| Operating cost reduction |
The goals of JAF's Physician Compliance Services
include the characteristic reduction of risk produced by a properly
conceived and implemented compliance plan, the simplification of clinical
documentation to simultaneously meet documentation requirements for proper
coding and reduced transcription volume (and related expense). Proper coding
is essential to maximizing revenue and minimizing risk.
JAF Consulting, Inc. (JAF), established in 1995,
has developed administrative and consulting expertise as they relate to
physician practice third party payor billing. We offer services encompassing
all phases of compliance with third party payor practices and
re-audit & negotiations of physicians who have been audited.
In 2000, the Health Care Financing
Administration (HCFA) issued voluntary Physician Practice Compliance
Guidelines. Learn about these guidelines and how they can be used to help your enterprise avoid costly and time consuming audits by payors.
While a Compliance Program Guidance is not mandatory, adhering to
the Guidance will serve as a step towards assisting providers in
preventing the submission of erroneous claims or engaging in unlawful
conduct involving health care programs.
Regulatory Agencies (OIG, DOJ) and third-party payors have initiated
aggressive audit programs to review compliance in both facilities and in
the small practice setting. A proactive approach can minimize the
retrospective impact and eliminate the prospective exposure.
Physician Compliance Program Essentials
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According to the Bureau of National Affairs,
Gary Thompson, an official with the Department of Health and Human
Services Office of Inspector General, ("OIG"), recently told a meeting of
healthcare lawyers that the OIG measures physician compliance programs as
follows: |
| whether internal monitoring and auditing
measures are valid and objective, and relevant to federal health care
program requirements; |
| whether physician policies and procedures
address risk areas, are accessible and understandable to employees, and
are current and complete; |
| the ability to verify compliance
oversight, and, if an organization or physician purports to have a
compliance officer, whether the officer has sufficient resources,
authority, skill, knowledge, and experience; |
| whether training and education programs
exist, and if appropriate employees were trained; |
| the physician’s response to detected
offenses, and whether corrective action was initiated; and |
| whether compliance communication
mechanisms are clear, can be identified by employees, and are
confidential. |
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WHAT IF…You could
be relieved of the worry of medical billing discrepancies?
WHAT IF…Your
patient audits by third party payors were to be less anxious?
WHAT IF…You
could potentially save tens of thousands of dollars in potential third party
payor charge backs?
We have the program that is right for your practice!
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Physician Compliance ... A Retrospective Program
| Development of a
work plan customized to the needs of the specific practice(s) and
medical specialty(ies). |
| Coordinate with
selected counsel, if deemed appropriate. |
| Integrate current
Practice Compliance Guidelines in a proactive program. |
| Perform medical
records reviews of the selected sample of inpatient and outpatient cases
for the year(s) under review. |
| Prepare a report of findings
including the quantification of errors. Extrapolate the results to the
total population. |
| Review the report
and determine a course of action. |
| Conduct
educational sessions for the administrative and medical staffs. |
Physician
Practice ... A Prospective Review
| Conduct general educational
sessions for the administrative and medical staffs regarding current
regulatory issues.
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| Medical record/bill audit of a sampling of
claims with written report discussing the findings and recommendations to
assist with billing compliance; and |
| Perform medical records
reviews of the selected sample of current billings for specific
departments/divisions.
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| Prepare a report of
findings and recommendations.
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| Conduct
educational sessions utilizing actual medical records examples identified
during the record review.
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| Assist with
the development and implementation of the necessary controls and
protocols.
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| Conduct post implementation
audits. |
For further information
regarding Physician Compliance services and to learn how JAF Consulting,
Inc. can assist your organization, contact us at 856-241-1900 or email
info@jafconsulting.com.
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