CMS – OIG Compliance Services and Training
An ethical, fraud-free business is the objective for every healthcare organization. But, creating an environment to maintain this corporate culture requires structured programs and training. The ‘Seven Fundamental Elements of a Compliance Program,’ as determined by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) are the functional framework upon which to build a compliant culture. The Seven Elements are the cornerstone of all our programs, training, and services, which help healthcare organizations remain in compliance with CMS-OIG regulations.
How we Assist
The 7 Elements of Compliance are foundation of our organization. Our team of certified compliance professionals audit and maintain the necessary components for healthcare organizations to maintain a strong culture of OIG compliance.
Compliance Program Effectiveness (CPE)
Simply applying the 7 Elements of Compliance does not ensure that your program will be effective. We measure a successful program by the continuity and application of best practices and outcomes and take immediate action to address inconsistencies and vulnerabilities.
Code of Conduct
Patients carry an inherent trust in the quality and delivery of health care. Upholding this trust is not only an essential public duty, but a requirement under the Affordable Care Act. Through our hands-on approach, we work with you to ensure that due diligence and ethical practice are the foundation of your corporate culture.
Comprehensive Compliance Manual
All of our manuals built to be site-specific through our two-step approach that includes an in-depth survey and on-site assessment. This personalized approach makes it easy to understand the best practices needed for your specific organization to be successful in maintaining a healthy culture of compliance.
We make it easy for your staff to understand their role in a successful compliance program and why it’s important for each individual to participate in this effort. We train them on exactly what they need to know for your specific organization and how to apply this training on an every-day basis.
Establishing your organization as a safe and trusted environment for your staff includes providing a compliance hotline. We provide an anonymous outlet for employees to air grievances and compliance concerns. When issues arise we work with you to address them so you can maintain a healthy work environment while mitigating the risk of elevation to a regulatory board.
OIG/CMS Exclusion Checks
You risk substantial fines and penalties if you do business with any individual or entity on the exclusion list, but it’s a burden on resources to devote the time required to properly monitor this. We will take on the task to make sure the individuals, providers, vendors, contractors, and subcontractors you do business with are in good standing with the OIG.
Policy Review (relating to HR, Finance & Billing)
Your best protection begins with comprehensive policies that are regularly updated and executed properly. We identify and resolve gaps that could leave your organization vulnerable, as well as lead the education and training of your staff on proper policy execution.
Payer & Regulatory Defense
In 2020, the OIG recovered approximately $1 billion in fraud, waste & abuse cases. These includes organizations of all sizes, as well as civil and criminal recoveries. If you find your organization in this situation, we are your best line of defense. We have worked with over XXX organizations on investigation and prosecution defense.
In order to adhere to the Seven Elements of Compliance, we audit your practice to see how well your OIG Compliance program stacks up. Since one of the required elements includes internal monitoring and auditing, we conduct a thorough assessment of your current written policies and procedures.
We conduct physical and remote audits of your practice, whether or not you have a designated Compliance Officer, strong annual training programs and new hire training. It’s also important to see that you have open lines of communication, and pre-designed methods to handle complaints or potential problems. We then provide our risk assessment and offer recommendations for improvement.
CMS – OIG Compliance requires a written program to demonstrate compliance with regulatory requirements compliance and your commitment to ethical business practices.
Once we’ve assessed your current rating, we’ll help you create a Risk Management Plan, a schedule that you will develop to remediate any open issues. This is accompanied by an internal manual and supporting documentation that defines the expectations, workflow, processes and procedures across key business activities. And, as the CMS-OIG issues updated guidance, we will work with you to update the manual accordingly, securely storing these electronic manuals and associated documentation in our custom Regulatory Compliance Management System.
Our training programs are designed to quickly bring your staff up-to-date on CMS-OIG requirements and their role in helping you better serve patients and protect your practice, partners and employees. We train them on exactly what they need to know for your specific organization and how to apply this training. As part of your ongoing employee engagement and OIG Compliance toolkit, we recommend you provide a compliance hotline, an anonymous outlet for employees to air grievances and compliance concerns. When issues are exposed, we work with you to address them so you can maintain a healthy work environment before they reach the attention of a regulatory board.
Recent CMS-OIG News
A year that has been unique in all our lives created compliance challenges across the board for healthcare businesses. We have asked HealthCare Compliance Network’s senior management to share brief observations on the compliance industry as they saw it from the...
You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your EHR is tight, the notes are voluminous, your providers are well versed at coding. If anything, you under code. You provide excellent care for your...