Health Reform Project and medical compliance in a medical practice
The Patient Protection and Affordable Care Act (Public Law 111-148), also known as the "law of reform of Medicare" known is a federal law that was signed by President Barack Obama March 23, 2010 This legislation. introduces a new requirement of an effective compliance program for health care organizations. What was once voluntary is now mandatory, including the requirement that healthcare providers who register as Medicare providers to have introduced a compliance program.
The Office of the Inspector General (OIG) of the US Department of Health and Human Services (HHS) recommends the elements of an effective compliance program include:
Track and internal audit
Development and implementation of policies and procedures of the compliance program
The appointment of a compliance officer or contact person
Perform a proper education and training of personnel
appropriately to crimes and developing corrective measures
The development of communication lines open, andPhysicians and other manufacturers that require the participation of Medicare is necessary to have a compliance program in place. It is unknown if this requirement will extend existing to a medical group health insurance, has not so far taken to contribute to a doctor or other professional who participate in Medicare - but it could!
Limiting the submission of applications for Medicare has been reduced for one calendar year from the date of delivery.
Overpayments to Medicare must be returned within 60 days from the date of the determination that there was an overpayment. The penalties are due 3 times the amount.
Registration Provider can be removed if he or she does not keep track of recommendations for health services DME home, and to make the records available to CMS available when prompted.
There must be a confrontation between the provider and the patient be encounter when health demand at home or DME. (HHS can also extend this requirement to other services)
It is a new protocol for self-disclosure violations provider of self-referral to a doctor rules.
States can use in the state Recovery Audit Contractors (RAC) for the testing of Medicaid.
A supplier may be terminated by Medicare termination of the Medicaid program of the State.
PQRI measures and HITECH Act Meaningful Use criteria will be integrated as far as possible. In the near future
There is no co-payment of Medicare beneficiaries for preventive services by preventing US workgroup services rated A or B may be required. Medicare for these services are charged 100% of the allowable Medicare.
Reduce Medicare payments to physicians who do not participate 1,5% in 2015 and 2.0% in 2016 in PQRI.
So what if a doctor?
to implement development and effective policies and compliance procedures, including internal control as a revision of the coding and documentation according to risk.
If you are a Medicare participating provider, begin submit PQRI measures.
Make your practices billing and receivables include the timely submission of claims and repayments in a timely government payors time when payments are identified.
Make sure that your EHR system is able to meet the meaningful use criteria.
Remember that 2010 may be a year, "moving aggressively into the future", because the future is whether you are ready or not!
Step by Step - - Since the Patient Protection and Affordable Care Act will be implemented regardless of the legal challenges, it is advisable to examine the potential impact on medical practice, including the need for a review of their documentation process medical coding and billing program policies and procedures and Head of compliance. All important steps to better reference standard clinical practice to manage.
