Building an Effective Compliance Management Program: What You Need to Know

To help prevent fraud and abuse – and all the punitive setbacks that come with broken health care laws and unmet regulations – having a robust compliance program is key. There is no one-size-fits-all approach to compliance management, however, and it is most effective to tailor your program to your organization’s structure and type. The following FAQs are designed to help you understand the basics and formulate next steps for your compliance program.

What is a compliance program, and why do I need one?

A compliance program is a set of internal policies and procedures that helps your organization comply with the law in its daily operations. A proactive plan helps you maintain compliance with today’s regulations, as well as providing a framework for implementing future requirements.

What are the basic components every compliance program should include?

Effective compliance programs include these essential components:

  • Written policies and procedures
  • Effective training and communication
  • Internal monitoring and auditing
  • Enforcement and discipline
  • Prompt action/response times for issues detected

Why should I customize my organization’s compliance program?

Every organization is structured differently, has unique staffing and contracting programs, provides a different mix of services, and has a specific profile of patient demographics and payer mix. While the basic essentials apply to any compliance program, the specifics will vary based on your organization’s unique operations, structure, and areas of risk.

What resources are available to help me customize my compliance program?

To help you develop a compliance program that is most impactful for your organization, the Office of Inspector General (OIG) has developed a set of principles, called Compliance Program Guidance (CPG). These guidance documents are geared toward different segments of the healthcare industry, including:

  • Hospitals, Nursing Facilities, Physician Practices, Home Health Agencies, Hospices
  • Medicare+Choice Organizations
  • Third-Party Medical Billing Companies
  • Public Health Services (grants)
  • Pharmaceutical Manufacturers
  • Clinical Laboratories
  • Ambulance Suppliers
  • Durable Medical Equipment, Prosthetics, Orthotics, and Supply Industry

Use the CPGs as a starting point, and then tailor them for your organization. The OIG provides many additional compliance resources to encourage effective internal controls to monitor and manage adherence to applicable statutes, regulations, and program requirements.

Also, remember that a compliance program is never done – it evolves with your business and with changing regulations. It is forward-looking, and focused not only on risk containment, but also on best care and management practices.

This sounds like more than my small team can manage. Can I outsource my compliance program instead?

Yes! At Vālenz™, we offer a range of compliance software and support solutions to help assure you are not the “last to know” about a sanctioned provider or other compliance issue. With three tiers of service to accommodate any need and every budget, we take the complexity out of compliance and deliver peace of mind. To learn how we help you protect your organization from the risks of non-compliance, call 888-395-9029.