Delaware County Medicine & Health Spring 2017 - 13

Designation of a Compliance Officer
Both the FSG and the OIG Guidance recommend that the
compliance function be led by a qualified chief compliance
officer ("CCO"). In a smaller MPO setting, the CCO often
has more than one role in the organization. In larger MPOs,
the CCO is a full-time position and he/she should be a key
member of the senior management team.
The OIG Guidance establishes that the CCO should have
direct access to the governing body (typically, larger MPOs
only), the president or CEO and all senior management.
OIG Guidance also recommends that the CCO have independent authority to retain outside legal counsel. This type
of authority is critical even in the smallest of MPOs, as the
compliance function needs to operate independently in its day
to day working relationships with key operational areas of the
MPO that have a clear nexus with the compliance function
on a regular basis (e.g., coding, billing).

Developing Open Lines of Communication
MPOs should foster a culture that encourages open
communication without fear of retaliation. OIG Guidance
advocates that healthcare providers establish an anonymous
hotline or other similar mechanism so that staff, contractors,
patients, visitors, etc., can report potential compliance issues.
There are a number of vendors that offer hotline services to
MPOs for fairly reasonable fees.
Mere establishment of a hotline, however, does not meet
this standard: its existence and availability must be publicized
within the MPO. Upon receipt, calls should be logged and
tracked (to establish possible patterns); and the caller should
be informed of the MPO's actions toward resolving the
matter. Regardless of the communication channel, all reports
of potential fraud and abuse should be investigated, and the
results shared with MPO leadership. The MPO should also
pursue appropriate remedies to any recurring problems.

Conducting Effective Training and Education Programs
OIG Guidance and industry "best practices" recommend
annual compliance training for staff by qualified personnel
regarding both general and specific training pertinent to the
bodies of law and regulation relevant to that employee's duties and responsibilities. OIG Guidance encourages MPOs to
evaluate the content of training and education programs on
an annual basis.
Industry standards also include mandatory attendance and
participation in training programs as a condition of continued
employment, and that failure to comply with training requirements will result in disciplinary action, including possible
termination, when such failure is serious. Adherence to the

provisions of the Program's training requirements should be
an important factor in each employee's annual performance
review.

Internal Monitoring and Auditing
The FSG and the OIG Guidance clearly document that an
ongoing evaluation process is critical to a successful Program.
The FSG and the OIG Guidance recommend that an MPO's
audit plan be evaluated on an annual basis to ensure that areas
of concern with respect to billing matters and relationships
with other organizations (particularly, referral sources) are
properly addressed. This evaluation process should consider,
for example, findings from previous years' audits, risk areas
identified as part of the annual risk assessment, and high volume services. As to the billing function, the audit plan should
include an assessment of billing systems to identify the
root cause of billing errors. Reviews of claims for accuracy
should include a review of all billing documentation, including clinical documentation.
Recovery audit contractor ("RAC") audits have become of
significant concern to all healthcare providers participating
in the Medicare program. MPOs should develop and refine
action steps to be taken in connection with these audits, as
they can be extremely disruptive to an organization in terms
of resource consumption and cash flow challenges.

Responding to Detected Deficiencies
The OIG and the FSG recommend that MPOs create
a response team, consisting of senior management team
members, the CCO and outside legal counsel (depending on
MPO size), to evaluate any detected deficiencies quickly. The
team should promptly investigate all matters thoroughly and
develop corrective action plans that take into account the root
causes of each potential violation. In the wake of a corrective action plan, the team should conduct periodic reviews
of problem areas to verify that the implemented corrective
action successfully eliminated deficiencies. In addition, there
should be protocols in place to address situations where a
detected deficiency results in an identified overpayment, to
ensure prompt and accurate repayment.
If improper conduct has been detected, the FSG require
that that an organization take reasonable steps to both
address it, and to prevent further similar misconduct. The
failure to prevent or detect improper conduct in and of
itself does not mean that a Program is ineffective. However,
the FSG make clear that a "recurrence of similar misconduct creates doubt regarding whether the organization took
reasonable steps to" achieve an effective Program. Thus, it is
important for appropriate remedial measures to be taken.

www.delcomedsoc.org

DELAWARE COUNTY MEDICINE & HEALTH

11


http://www.delcomedsoc.org

Table of Contents for the Digital Edition of Delaware County Medicine & Health Spring 2017

Delaware County Medicine & Health Spring 2017 - 1
Delaware County Medicine & Health Spring 2017 - 2
Delaware County Medicine & Health Spring 2017 - 3
Delaware County Medicine & Health Spring 2017 - 4
Delaware County Medicine & Health Spring 2017 - 5
Delaware County Medicine & Health Spring 2017 - 6
Delaware County Medicine & Health Spring 2017 - 7
Delaware County Medicine & Health Spring 2017 - 8
Delaware County Medicine & Health Spring 2017 - 9
Delaware County Medicine & Health Spring 2017 - 10
Delaware County Medicine & Health Spring 2017 - 11
Delaware County Medicine & Health Spring 2017 - 12
Delaware County Medicine & Health Spring 2017 - 13
Delaware County Medicine & Health Spring 2017 - 14
Delaware County Medicine & Health Spring 2017 - 15
Delaware County Medicine & Health Spring 2017 - 16
Delaware County Medicine & Health Spring 2017 - 17
Delaware County Medicine & Health Spring 2017 - 18
Delaware County Medicine & Health Spring 2017 - 19
Delaware County Medicine & Health Spring 2017 - 20
Delaware County Medicine & Health Spring 2017 - 21
Delaware County Medicine & Health Spring 2017 - 22
Delaware County Medicine & Health Spring 2017 - 23
Delaware County Medicine & Health Spring 2017 - 24
Delaware County Medicine & Health Spring 2017 - 25
Delaware County Medicine & Health Spring 2017 - 26
Delaware County Medicine & Health Spring 2017 - 27
Delaware County Medicine & Health Spring 2017 - 28
Delaware County Medicine & Health Spring 2017 - 29
Delaware County Medicine & Health Spring 2017 - 30
Delaware County Medicine & Health Spring 2017 - 31
Delaware County Medicine & Health Spring 2017 - 32
http://www.nxtbook.com/hoffmann/delcomed/DelcoMedicalSocietySummer2019
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietySpring2019
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietyWinter2019
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietyFall2018
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietySummer2018
http://www.nxtbook.com/hoffmann/delcomed/DelcoMedicalSocietySpring2018
http://www.nxtbook.com/hoffmann/delcomed/DelcoMedicalSociety
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietyWinter2017
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietyFall2017
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSocietySpring2017A
http://www.nxtbook.com/hoffmann/delcomed/DelawareCountyMedicalSociety
http://www.nxtbookMEDIA.com