Over the years efforts against fraud and for patient safety have progressed. This is made evident by the growing regulations, as well as the harsher sentencing guidelines. So it comes as no surprise that efforts for creating a culture of compliance in healthcare has and remains a hot topic throughout the industry. Much has been debated on the subject, but what seems to be agreed amongst most is the call for adopting an active culture rather than a passive or reactive one. In other words, preparing staff in a manner in which they may be prepared for whatever may come.
With that said, how does one go about creating a culture of compliance in healthcare? What are the must-have components to ensure that your initiatives are successful? This blog attempts to answer these burning questions and more.
1.Frequently conduct internal billing and coding audits
Billing and coding audits should be performed at minimum twice a year, but there’s no harm in doing it more often to keep staff on their toes. Ideally, periodically, an outside auditor should be invited in to ensure compliance with third-party payors.
Specifically, internal audits should focus on areas which have a high concentration of procedures or outlier Medicare payments. Doing so will help you to determine whether or not the services rendered were necessary.
2.Train and educate staff
Too often, in healthcare and in business, organizations have one-time training sessions for new hires. This information is provided and likely forgotten, not to mention handouts and manuals are left to collect dust or find a permanent home on the bottom of a filing cabinet. Conducting periodic education sessions for employees on compliance is a great way to offer refreshers and share new policies and procedures being introduced to the organization. What’s more, these sessions can be used to test employees and provide management with insight as to which members need a little more help. Having these frequent discussions could be the difference between having a successful plan and not.
3.Have a dedicated compliance officer
Sometimes due to budget, the role of the compliance officer is added to an already existing role within an organization. This may not be the best way to approach an active culture of compliance, as often times it’s ideal to have a dedicated individual leading the charge. In doing so, you ensure this individual is highly visible to your staff, and reinforce the importance of the subject matter to your organization.
4. Respond and communicate appropriately
When an employee reports an misconduct, it’s important to thank the individual and keep them updated with the actions you are taking. Never should an employee be reprimanded for reporting an incident.
5. Make it meaningful
Perhaps the most important part of it all. Break down the impact for each employee so that they understand that no matter how big or small the part, that everything is tied together. In the end, compliance is everyone’s job, and adding meaning to their actions provides a sense of purpose. This could be the biggest differentiator in your program compared to everyone else and could be what determines if your compliance program succeeds or not.
Compliance is all around us, there’s no dodging it, or ignoring it–only embracing it. The first step isn’t building a stellar program, but to understand that you need your entire staff to be on board in order to be successful at your task. This includes having the proper support system in place to ensure their concerns don’t fall on empty ears. Once you do, you’ll be surprised to realize that most of the heavy lifting will be complete and all that’s left to do is reinforcing what your staff already know!