Billing: Manage your risk

Q. How can I stay compliant with Medicare’s fee-for-service plans? 

A. Dealing with Medicare fee-for-service plans can be tricky, but there are ways to manage the risks and stay compliant. Documentation errors are a primary risk, as Medicare is extremely strict, and any mistakes can lead to claim denials or audits. To avoid these risks, ensure all patient records, prescriptions and proof of delivery are thoroughly documented and easily accessible. Billing inaccuracies, such as incorrect coding or billing for non-covered services, can result in denied claims and accusations of fraud. Consistently auditing billing and documentation practices will ensure accuracy and help identify potential issues early. 

Regulatory changes play a key role in the internal audit program, as Medicare rules and regulations change often, requiring continuous adaptation to stay compliant. Subscribe to industry newsletters, attend webinars and join professional associations to keep up with updates. Work closely with your compliance officer or manager and budget for membership fees, educational webinars, and consulting. Medicare has specific supplier standards, such as maintaining a physical facility, proper licensure and quality standards. Regularly reviewing these standards and conducting internal audits ensures compliance. 

To manage these risks effectively, set up a comprehensive compliance program. This includes detailed policies and procedures, regular staff training and a designated compliance officer. Foster a culture of transparency and accountability in your organization. For example, implement a whistleblower policy so employees can report any concerns without fear of retaliation. A compliance hotline is a positive step in the right direction, providing the level of security and confidence all employees want and need. 

By proactively addressing these risks and maintaining strong compliance practices, you can navigate the complexities of Medicare fee-for-service plans more effectively and avoid potential pitfalls. 

Kit Shellhouse is director of business development for the van Halem Group. Reach her at Kit@vanHalemGroup.com.