Compliance Officer (CMCO)
is a strategic move. Medical office professionals who expand
their compliance knowledge now will have the edge in today’s
ever-changing health care climate.
Why You Need It
Each day that passes without an effective compliance plan
increases your risk of staggering fines, penalties or even
criminal liability if an auditor uncovers overpayments or
alleged fraud. It is no longer a question of whether or not a
practice will be audited by a third party, but when.
The evolution of health care is changing the way we handle
patient records, write prescriptions, bill for services, work
with physicians, hospitals and DMEs, etc. As if all of this
weren’t stressful enough, the Office of the Inspector General (OIG)
is watching and commanding total compliance with applicable
rules and regulations.
Lack of knowledge won’t hold up in a federal audit.
Medicare and Medicaid have expanded audit contractor programs to
squash fraud and waste. RAC/ZPIC or other contractors have been
authorized by Medicare to come in to your office and request
dozens, even hundreds of claims, with little notice and you must
comply. Remember, even honest mistakes can trigger an audit.
Don’t be intimidated.
This is scary stuff, but for us, it’s a natural fit. We know
this subject inside and out. PMI has spent 30 years teaching
medical office professionals how to do it the right way. This
program was carefully developed by leading compliance experts,
Robert W. Liles and D.K. Everitt. They teach this course in a
way that you will understand, sharing real-world compliance
examples relevant to your office. You’ll learn to handle tough
situations with ease.
Is your organization prepared for greater accountability?
The OIG expects all health care organizations to be compliant
with health care laws. This goes well beyond a paper document
stuck in a file. It represents a functional, ongoing program
with factors such as measuring effectiveness, proper training,
review and update of policies and procedures. Your practice will
be held accountable for new fraud and abuse risk areas that may
arise as your organization becomes involved with new payment and
delivery systems (such as medical homes, accountable care
organizations, bundled payments, and value-based purchasing).
The severity of fines for false and fraudulent claims and
kickbacks is staggering. As an example, the OIG has set the
minimum settlement amount for violations of Self-Disclosure
Protocol (SDP), under both the anti-kickback statute and the
physician self-referral (“Stark”) law at $50,000 and up to three
times the total remuneration.