The concept of a compliance program is new to many in private practice physical therapy. However, it’s a necessary aspect of any practice. Here are some common questions (and answers!) regarding a compliance program:
What is a compliance program?
A compliance program is a set of checks and balances to ensure that a physical therapy practice is meeting its established standards. Another way to look at it is that compliance is a quality program to ensure a clinic is following best practices.
Why do I need a compliance program? There are many reasons for having compliance program:
- In some states, it is the law.
- Some insurance providers now require physical therapy practices to demonstrate what they are doing for compliance as part of the credentialing/re-credentialing process.
- Physical therapy practices are coming under ever greater scrutiny through such things as:
- Claims-Based Functional Outcome Measures
- Onsite visits by insurance providers
- Increased number and type of physical therapy documentation audits by insurance providers
- In my opinion, the most important reason for having a compliance program is to be able to prove to anyone that we as practitioners are making a reasonable attempt to comply with all regulatory requirements and have established the necessary procedures and controls to do so.
Now, you may be thinking: “Those are some good reasons for some practices to establish a compliance program, but I’ve never had a problem before and I use a compliant documentation system. So, why would I need a compliance program?”
I can understand this question. Some practices have had a degree of success by doing things a certain way and when you have had success there is a reluctance to change. Others may be pretty much at their limit and may be thinking: “I can’t handle one more thing.” But let me share something with you: I am a member of the Health Care Compliance Association and they publish a weekly newsletter. Below are just a few of the compliance related headlines from last week:
- EMH Regional Medical Center and North Ohio Heart Center to Pay U.S. $4.4 Million to Resolve False Claims Act Allegations
- Most Docs Not on Par With Medicare PQRS Quality Reporting Standards
- Owner of Detroit Adult Day Care Centers Pleads Guilty in Connection with Medicare Psychotherapy Fraud Scheme
- Detroit Doctor Pleads Guilty in Connection with Medicare Psychotherapy Fraud Scheme
- Former Owners of Medical Billing Practice, Pathology Groups Agree to Pay $140,000, Settle Claims that Patients’ Health Information was Disposed of at Georgetown Dump
- Man Wanted for Medicare Fraud
- DOJ Sentences another Former Orthofix Employee for Medicare Fraud
- NJ Health Department Apologizes After Privacy Breach in Email to Medical Marijuana Patients
- University of North Carolina Unit Breached
And this is just last week! Notice, there are issues reported with HIPAA, PQRS, False Claims Act, and fraud. I cannot stress enough the importance of a compliance program to avoid these issues. Still, I know everyone needs to know the benefits before they commit, so here they are:
- Assurance in your cash flow. It is not how much you get paid to provide physical therapy services, but how much of that payment you get to keep. Through your compliance program, you will ensure that your staff applies the appropriate billing guideline correctly. By performing internal documentation audits, you can also make sure that the services you provide are justified as medically necessary. Additionally, through a compliance program, you can properly show through documentation when your practice is collecting deductibles and co-pays and when it’s not. Remember, it is illegal to intentionally not collect deductibles and co-pays unless you can document a financial hardship.
- Promote trust. Having the appropriate checks and balances—and communicating those to your employees—will foster trust within your practice. A compliance program also creates an atmosphere of trust with payors and regulators.
- Promote confidence. By providing your staff with proper training on your compliance program, on billing appropriately, and documenting effectively, you and your staff can be confident that the services you’re providing are justified.
- Fewer sleepless nights. Lastly, putting a compliance program in place can eliminate that nagging in the back of your mind at night that with all the changes taking place in healthcare, you should be doing something, anything. Instead, rest assured because you have done just that. You’ve put in place a compliance program that protects your practice, your staff, and your patients.
We’ve discussed what a compliance program is, why it’s essential to your practice, and what benefits you would experience by implementing one. Here are a couple of references to get you started:
For you do-it-yourselfers, check out the Office of Inspector General’s Compliance Guidelines. Additionally, some networks such as PTPN offer an outline of a compliance plan for their members, but you have to be willing to put in the work.
For those wanting a more full-service individualized solution, a healthcare attorney will write a compliance program specifically for your practice. This is the most expensive route. However, for WebPT Members, PT Compliance Group will customize a compliance plan for your practice and provide an extra hour-long consultation on how to implement your compliance plan for a special discounted rate. Contact the PT Compliance Group at firstname.lastname@example.org or 888-680-7688 for more information.
Thank you as always for this opportunity to chat with you about compliance. If you have any questions or comments, post them in the comments section below or shoot me an email (email@example.com).