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Seven Ways to Manage Billing Compliance and Reduce Fraud

Billing compliance is an essential component of every successful medical practice. However, many practices don’t have the time or resources to maintain a good compliance plan.

This article explores seven ways to manage billing compliance and reduce fraud through an effective compliance program. Read on to learn how to implement your compliance program starting today.

Why Is Billing Compliance and Fraud Reduction Important?

Medical practices know they should focus on healthcare compliance, but they struggle to know where to start if they don’t have a plan.  Physician practices are primarily focused on patient care and streamlining existing workflows.  They don’t have time to add another responsibility to their load, especially as daunting as healthcare compliance seems.  They also may not have the resources to hire a full-time employee to explore and implement their compliance programs.

However, if practices don’t have a compliance plan in place and are fined for fraudulent billing, the costs of damages can be devastating. Providers who are found guilty of fraudulent billing knowingly did something to defraud a healthcare program. Providers can also be found guilty of abuse, which means they did something that resulted in unnecessary costs to the healthcare program, but it wasn’t necessarily intentional.  Depending upon the situation, consequences for providers can include huge fines, loss of licenses, jail time, the inability to participate in government programs such as Medicare and Medicaid, and the loss of other payer contracts.  Practices can be forced to shut down in particularly bad cases.

Certified compliance officers exist to provide professional compliance help to practices without the resources to manage their compliance in-house. The goal of a compliance officer is to protect physician practices and keep them out of trouble with government agencies. When billing government payers like Medicaid or Medicare, it is essential to have measures in place to make sure fraudulent claims are not being billed. When you hire a compliance officer to help manage billing compliance, you can have peace of mind that you’re pursuing compliance at every juncture.

Larsen Billing’s compliance team has the ability, skill set, and experience to help your practice wherever you are in your compliance journey. We can start your compliance plan from scratch or help you continue your pursuit. Medical compliance doesn’t have an endpoint; you’re continuously working toward it. Larsen Billing can help you get started today.

Putting an Effective Compliance Program in Place

Every physician practice should have a compliance plan in place. Creating and implementing a compliance plan requires time and energy that most practices don’t have to spare. Compliance management is daunting, and most smaller practices don’t know where to begin.

Our team has compiled a step-by-step method for implementing an effective compliance program for your practice. Learn how Larsen Billing can create, implement, and successfully execute a compliance plan for you.

Designated Compliance Officer

Most practices don’t have the resources to hire an in-house employee to manage compliance. Those same providers also lack the resources to handle these tasks themselves. As a result, compliance is pushed to the side or forgotten about entirely, which –– as we explored above –– can destroy a practice.

Providers don’t have to choose between hiring in-house compliance staff or neglecting their compliance altogether. Practices and providers can employ a designated compliance officer to manage their compliance remotely. This provides practices with access to expertise and talent without the overhead costs of bringing someone in-house.

Writing Out Policies and Procedures

Establishing practice standards and procedures is essential for effective billing compliance. Your practice needs written policies against which compliance can be measured and evaluated.

Policies and procedures should be written, approved, and accessible to all office staff. This ensures that all parties know regulations, expectations, and the consequences of intentionally or unknowingly breaking compliance guidelines.

Effective Training and Education

A compliance plan is only effective if your staff is properly trained to understand and implement it. So that you know, every member of your practice must understand the plan and undergo formal training.

Education empowers your team to work efficiently, reduce errors, and protect your practice against the consequences of preventable mistakes.

Effective Lines of Communication

All team members must feel safe identifying and reporting risk areas within their practice. If employees perceive or suspect a risk, they need a path to communicate these issues without fear of retaliation safely.

Could you provide effective lines of communication that empower your staff to formally report risks or instances of noncompliance? This creates a better work environment, provides staff support, and helps your practice move forward with clarity. This is one of the most protective things you can implement so that your entire staff is working to mitigate risk for your practice.

Internal Auditing

Regular claims auditing is necessary to keep compliance risks at a minimum. If you aren’t conducting regular audits, you cannot identify your areas of weakness.

Thorough, professional audits ensure your practice follows compliance procedures and takes the necessary steps to reduce the risk of billing fraud.

Well-Publicized Disciplinary Guidelines

If someone violates your policies, what’s going to happen? An effective compliance plan answers that question. You can’t uphold the policies if you don’t have a discipline plan in place.

Your plan should include well-publicized disciplinary guidelines for noncompliance. Including disciplinary actions in your plan helps you know which steps to take should someone knowingly go against your guidelines and commit fraud.

Promptly Responding to Areas of Concern

Your compliance plan will continuously evolve along with your practice. While a certified compliance officer exists to help you work toward compliance, risks and concerns will inevitably arise. What you do when risks are reported dictates the direction of your compliance journey.

Your plan and your officer will be sure to let you know your responses to areas of concern. How will you address risks, and what is your timeliness for responding to reports? Your compliance strategy should include response plans to handle quickly and correct risks.

Protecting Your Practice with Larsen Billing

Larsen Billing can assist you if you are among the many small physician practices needing compliance help but don’t know where to start.

At Larsen Billing, we provide expert compliance services, meeting your needs from the beginning of your compliance journey and assisting you along the way. We offer the following services for your practice:

  • Help you appoint a compliance officer or provide one for you
  • Conduct risk analyses and charts audits
  • Create written compliance policies and procedures
  • Provide staff training and education

Our certified compliance officer will set up a free consultation to begin your assessment, starting with a risk analysis. A risk analysis is an easy first step to determining your needs and how to move forward. After your evaluation, we will reach out to you to build your compliance plan.

Our team can help protect your practice by creating your custom compliance plan, implementing it, and helping you continue the journey to compliance. Larsen Billing is here to give you greater peace of mind by ensuring your practice is protected. Please feel free to reach out today to learn more about how we serve practices like yours with our compliance services.