Attack audit challenges with compliance programs

Friday, October 19, 2012

ATLANTA – Providers must make compliance a priority because the stakes have never been higher to get paid and stay paid, a powerhouse panel of industry stakeholders said at Medtrade.

“There are armed FBI agents who have been raiding HME companies across the country,” said John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers during the Oct. 18 session, “Tales From the Trenches: True Life Compliance Problems and How to Fix Them.” “So you know they’re serious about it.”

There’s still no implementation date for a requirement in the Affordable Care Act that providers have compliance programs in place.

Still, with 18 separate kinds of audits underway, panelists said compliance programs can not only prevent providers from being investigated in the first place, but also protect them if they are.

“They will look at it and they will give you credit for it,” said Walt Gorski, vice president of government affairs for AAHomecare.

Tips from panelists included meshing your compliance and accreditation efforts; using your compliance program as a selling point with referral sources and payers; and recognizing that your efforts may sometimes put your compliance officer at odds with other managers in your company, especially those in sales.

“It’s OK to have tension,” said Jeff Baird, a healthcare attorney with Brown & Fortunato.

A nice byproduct of taking compliance seriously, panelists said: improved overall operations.

“You want to bill and keep your money—that’s a big part of it,” said Laraine Forry, owner of LMF Billing. “But this can help operationally—that’s what compliance is.”

With the Office of Inspector General on the record recommending compliance programs since 1999—it recommends programs include things like written standards, policies and procedures; a compliance officer; and effective training—providers have had more than enough time to get up to speed, panelists said.

“We have to be certain that what we say we’re doing we’re really doing,” said Georgie Blackburn, vice president of government relations and legislative affairs for Blackburn’s. hme