Our Compliance Services at MAS
To ensure compliance with required OIG regulations, it is important to have a comprehensive compliance program in place. Medical Auditing Solutions has implemented successful OIG Compliance Programs and this includes developing and implementing policies and procedures that align with OIG guidelines, as well as providing regular training to employees on the importance of compliance. Auditing should also be conducted regularly to identify any potential areas of non-compliance and take corrective action as needed. By prioritizing OIG compliance, organizations can safeguard against unethical practices and protect both their employees and stakeholders. We offer fractional compliance program management to medical, DME and all healthcare providers.
OIG Compliance Program Development & Implementation
If you accept Medicare, Medicaid, Tricare, or Federal Retired plans as a provider, it is mandatory to have compliance program guidelines that include policies and procedures. We understand that this can be a source of confusion for many doctor and dental offices.
Guidelines have been available since the 1990s but have been mandatory since 2013. On April 24, 2023, OIG announced its plans to improve and update existing CPGs and to deliver new CPGs specific to segments of the healthcare industry or entities involved in the healthcare industry that have emerged in recent years.
Since it’s hard to keep up-to-date on compliance issues while also running your office, many offices choose to outsource their compliance needs to specialists.
You need a compliance program with policies and procedures because:
- Payer contracts ask about your compliance program when you apply to be a provider.
- On their contract applications, commercial plans ask for confirmation that you have a compliance program and require it to be produced in an audit with overpayment findings.
- In overpayment audits, they ask for your compliance program information.
- A compliance program, despite being a cost center, can actually save the company money.
MAS Helps with Compliance Program Development & Implementation
Medical Auditing Solutions is qualified to provide fractional compliance services to develop and implement your medical, DME, or healthcare office’s compliance program, offering a comprehensive range of services tailored to meet the unique needs of your business.
QUALIFIED STAFF: We have experienced staff certified in healthcare compliance and a billing company that has been certified healthcare compliant that can help you create a custom compliance program for your organization.
STANDARD PROGRAMS: We’re not fans of buying off-the-shelf programs because: 1) companies rarely read them, 2) many items may not apply to your particular business, and 3) if you have policies unenforced then businesses leave themselves open to liability issues.
OUR CUSTOM FRACTIONAL COMPLIANCE PROGAMS: We review your business model, make the process interactive, and the end result is a compliance manual you can use. Not only will this manual include information about the Stark, Antikickback Statutes, but there is also 5-6 hours of training as well that will cover all information in elementary detail so everyone will have a clear understanding. We will review your billing and collection reports monthly to help identify problems before they escalate. We include audits and monthly “advisory” hours will be included. We want to bring experience to help guide you in your business, whether that’s asking the questions and gathering information so when you do talk to an attorney the time used with them is efficient. We see so many providers that don’t talk to an attorney first and find themselves in difficult situations, we want to help guide you although we do not provide legal advice. We are to help make the time spent with your attorney efficient. All staff have more than 30 years experience in DME revenue cycle and compliance. Have a Compliance Program at the Fraction of the Cost of a Part Time person.
We pay careful attention to:
CONTRACTS: We can also help review your contracts to ensure there is work required and reported for payment.
VENDORS: Relationships with any vendor that provides a billable good or service to your business, the provider, is a high risk. Relationship violations can result in false claims which is 3x damages plus $11K per claim line or more. It is a significant risk if this this not being monitored in your organization. Some payers are now looking at adding RICO (organized crime) charges along with fraud/false claims to have a higher chance of putting you out of business.
We offer affordable solutions to help reduce your risk as a medical or dental provider.
Case Study
Mrs. Miller-Leathers ran a compliance program for a regional durable medical equipment and closed door pharmacy (DME). After about 4 years of working with this client, a particular employee apparently thought she was a doctor. We investigated for 3 months and gathered information and performed a self-disclosure. Usually, in these situations, penalties start at a multiple of 3, there are executive sanctions, and a costly big accounting firm is hired to audit the organization annually with a corporate integrity agreement (CIA). Instead, the company had a penalty of 1.5 multiple, no executive sanctions, and no CIA.
A well-thought-out compliance program that is monitored by an expert makes all the difference in the world when the unexpected happens. In this case, it resulted in a huge Return on Investment (ROI) or savings to the organization.
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OIG Compliance Training
Do you struggle to meet the annual 5 hours of required compliance training for OIG Compliance? Do you provide at least 1 hour of HIPAA training to staff annually?
If you’re not currently compliant, you’re not alone. With so much to do while running your business, sometimes OIG compliance training gets lost in the list of priorities.
But being non-compliant can have expensive consequences. Rather than viewing compliance training as a burden or expense, think of it as a necessary investment in your operations.
If you don’t have the resources or staff on-hand with the expertise to effectively implement and enforce compliance policies, it might be easier on your office to outsource your compliance training.
At Medical Auditing Solutions, we can help you take steps to ensure your employees are knowledgeable and compliant by managing your compliance services program.
How MAS Helps with OIG Compliance Training
Mrs. Miller-Leathers brings knowledge far beyond the OIG compliance recommendations for training. She has been through hostile FBI investigations, proactive self-disclosures, voluntary refunds, arbitrations, and various payer audits. She believes in training beyond just the basics so that your staff will be better prepared to handle whatever comes their way.
MAS’s OIG Compliance Training fulfills the mandatory training requirements of OIG Compliance Programs for Federal plans (Medicare, Medicaid, Tricare, and Fed Employee plans). As a note, all your commercial payer contracts ask if you have a compliance program.
Training gives staff the knowledge to prevent billing errors that the provider will be held liable for in investigations.
With payer guidelines changing frequently, compliance training alone is not sufficient. Your staff also needs to be on listserv for each payer and attend organizational training such as AAPC. Medicare also has free webinars on its CMS website. Training must cover the Stark, Antikickback Statutes, that is covered in a clear concise manner. MAS can help you organize all this and make sure you have access to the correct resources.
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