ObamaCare, also known as PPACA (Patient Protection and Affordable Care Act) has new mandatory rules for protecting patients when they see a healthcare provider. There are serious consequences for failure to comply and no excuses. In fact, ignorance is considered an admission of guilt if an infraction is discovered.
Regulations promise ‘to take into consideration” if you are making “a reasonable effort” to be in compliance when determining fines. No effort is considered “purposeful non-compliance” with a starting fine of $150,000 for each problem, up to a 1.5 million.
“Word from CMS is “every chiropractor” in the country is going to be audited. Some experts predict most offices will see 3 audits. I’ve already had my first. Are you ready?” Dr. Don Cross
To help you understand what’s involved in avoiding 6 figure fines, here’s a Dozen D’s you must KNOW and IMPLEMENT to comply with the new requirements.
- Document the established compliance standards and procedures followed by the practice owner(s), employees and agents who may possibly intentionally or otherwise violate PPACA.
- Delegate with authority to specific people of high level the overall responsibility to manage, enforce and report on compliance.
- Detect with Due Diligence that the delegated person(s) are able to manage, enforce and report on compliance, and that they aren't likely to engage in criminal, civil, and administrative violations under PPACA.
- Disseminate the procedures and standards of the office’s compliance with PPACA to all employees and agents, effectively communicating with required reading and/or training programs individualized to the practice.
- Design, Direct and Detect the reasonable steps to achieve compliance for the practice, including internal monitoring and auditing to detect criminal, civil, and administrative PPACA violations by staff and other agents, AND create and publicize a reporting system for staff and other agents to report violations by others within the organization without fear of retribution.
- Discipline violations, including any individual’s failure to detect or report any PPACA offense, and Deter future offenses by all reasonable steps, including modifying the office program to prevent and deter PPACA violations.
- Drill up and down within the organization’s processes to identify and assess necessary changes to avoid PPACA violations.
There is a Brighter Side - Making Lemonade Out of Lemons
Getting organized is a good thing, and the OCCM manual is a template to help you document and implement processes for your practice IN ADDITION to PPACA requirements.
- Fewer claims denied = greater collections
- Fewer rejects = shorter wait for payment
- More accurate coding = higher reimbursement
- Well trained staff = less turnover
- Organized systems= less stress, less wasted time
- Consistent oversight = less employee theft. (Healthcare has the 3rd highest rate of employee theft.)
- All of the above = better bottom line!