OIG & Regulatory Compliance

The Office of Inspector General (OIG) compliance programs help promote ethical and lawful corporate conduct. Compliance Programs promote detection, prevention and resolution of healthcare provider conduct that does not meet federal and state law and a hospital or health system’s business policies, which demonstrates a “Culture of Compliance”.

DoctorsManagement, LLC has extensive experience with OIG corporate compliance programs, so you can trust our experts to assist with your regulatory compliance needs. We offer services to address your practice’s unique compliance requirements so you can focus on your patients and essential business tasks.

What Is a Regulatory Compliance Program?

With the passage of the Patient Protection and Affordable Care Act of 2010, physicians who treat Medicare and Medicaid beneficiaries will be required to establish a compliance programA regulatory compliance program keeps your practice updated on constant regulatory changes through various processes and policies. An effective program helps you maintain compliance and experience benefits such as:

• Concretely demonstrate to employees and the community at large the organization’s strong commitment to honest and responsible provider and corporate conduct.
• Provide a more accurate view of employee and contractor behavior relating to fraud and abuse
• Identify and prevent criminal and unethical conduct.
• Tailor a compliance program to an organization’s specific needs
• Improve the quality of patient care
• Create a centralized source for distributing information on health care statutes, regulations and other program directives related to fraud and abuse and related issues
• Develop a methodology that encourages employees to report potential problems

The goal of a compliance program should be to build out your compliance framework so it can easily adapt to regulatory changes. As your organization maintains compliance, you can limit government scrutiny, mitigate financial risks, and offer patients the best quality of care.

How Do OIG Compliance Programs Help?

To help hospitals, physicians and other healthcare providers develop comprehensive compliance programs that comply with relevant federal health care laws and regulations, OIG offers compliance resources. These resources include:

• Advisory bulletins
• Brochures
• Articles and papers
• Podcasts
• Videos

The OIG also provides other applicable guidance on compliance with federal health care program standards, and they give their opinions regarding federal anti-kickback statutes and other fraud and abuse authorities. OIG resources are often tailored to providers, enabling organizations to find the educational resources they need to understand their regulatory requirements. With an understanding of federal rules and regulations, healthcare practices can form comprehensive programs that enable them to maintain compliance.

Our Healthcare Regulatory Compliance Services

DoctorsManagement can help your organization review OIG compliance resources and your current compliance framework to identify improvement opportunities. We can assist with various compliance support services, ranging from direction to advanced compliance services. Our capabilities include:

• Coding & Documentation Review
• Coding & Compliance Audit
• Production Coding
• Audit Appeals and Defense
• Fraud & Expert Witness
• Data Extrapolation and Review
• Identify and Mitigate Coding & Billing Risk
• Compliance Risk Analyzer (CRA) Data Analysis
• Risk Assessment Category Assistance
• Internal Review Code Selection
• Validation of Training & Mediation Programs

The Importance of Programs for Regulatory Compliance in Healthcare

The modern healthcare regulatory environment is complex and ever-changing. Compliance affects several aspects of a healthcare organization, from patient and employee safety to risk management and fraud prevention. Healthcare practices need effective programs, tools and resources that enable them to understand and manage their compliance needs.

Patient Safety

Most regulations are developed with patient safety in mind, specifically for identity protection. Healthcare organizations need to create secure processes for collecting, storing, handling and sharing patient information so they can protect their patients and ensure their satisfaction. An effective compliance program can identify problem areas and suggest improvements that address minor issues before they escalate into situations that put patient safety at risk.

Risk Management

Compliance programs enable organizations to manage noncompliance risks with proactive processes such as:

• Staff training: Educating staff members on proper compliance procedures can promote awareness of best practices and mitigate potential risks.
• Audits: Organizations should consistently review policies and make adjustments to ensure continual compliance.

Quality Assurance

Complying with federal, state and organizational policies helps practices improve operational efficiency in ways that affect quality of care. As healthcare organizations review policies and ensure they are updated with changing regulations, they can maintain quality assurance in patient care and operational effectiveness.

Fraud Prevention

To prevent fraud and financial loss, healthcare organizations need effective compliance plans that keep them informed of relevant laws. Programs also enable practices to detect and resolve any conduct that may not align with federal and state regulations, organizational policies and ethical standards.

Healthcare Worker Protection

Several regulations, such as the Occupational Safety and Health Act, focus on adequate safety standards for the healthcare workplace. Compliance programs should take staff safety into account by forming policies and processes that protect workers as they accomplish various tasks.

Discover Comprehensive Regulatory Compliance Solutions With DoctorsManagement

DoctorsManagement is a full-service healthcare consulting firm with in-house experts ready to support your goals. Our consultants work alongside your healthcare organization to help you experience the benefits of compliance, such as financial risk mitigation, patient satisfaction, employee morale and staff stress relief.

DoctorsManagement’s strategies have been proven over five decades of experience. When you partner with us, you’ll gain access to a team of nationally recognized industry experts ready to assist with compliance advisory services. Our capabilities include:

• Compliance
• Coding
• Healthcare analytics
• Auditing
• Human resources 
• Patient retention

Request a Free Consultation

DoctorsManagement can help you streamline your regulatory compliance approach. Our professionals will assess your compliance program to confirm it has appropriate policies, practices and procedures in place to address regulations relevant to your practice.

Request a free consultation to learn more.