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.

“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

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

  • 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.

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!

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.
  • 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.
  • Prepare a report of findings and recommendations.
  • Conduct educational sessions utilizing actual medical records examples identified during the record review.
  • Assist with the development and implementation of the necessary controls and protocols.
  • 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.