You've read the headlines. You've sat in the seminar listening to the slick-talking "expert" scare you with one story after another about how you are going to go to jail if you're not compliant and how your life will be ruined (especially if you don't buy a $1,500 colossal compliance binder). Perhaps you even know a friend who got on the backside of an audit that didn't turn out too well; or maybe you've even had a close call yourself.
Deep down inside, you know you should do something about becoming more compliant – but you haven't done much about it yet. And you wonder if you can "cheat death" and practice another year without addressing that nasty old issue of compliance. Before the feelings of guilt and shame overwhelm you, let me share some shocking news: You don't need a compliance manual.
I know that everything you've ever heard, read or assumed says you need one, so why in the world would I tell you that you don't? "Necela's gone off his rocker!" you might be thinking right about now. "What a shame. After all, wasn't he the first chiropractor to become a certified medical auditor? And isn't he the guy who is also a certified professional coder and a compliance professional, of all things? Shouldn't he know a thing or two about basic compliance?"
If you are thinking these things, I don't blame you a bit. But rather than talk about myself in the third person, let me be more specific and explain.
Compliance Is Not Simply...
First, there is a huge risk for chiropractors who are not compliant – and that represents a lot of you. However, becoming compliant is not what most DCs think it is. Despite your best intentions, compliance is not simply a matter of a few items such as:
- Having your new patients sign a HIPAA privacy form
- Paying an attorney to create a compliance "plan" for your office
- Assigning a compliance officer to handle compliance issues
- Signing a page in the compliance plan binder that sits on your shelf
- Having your employees sign a compliance agreement
- Hiring a consultant to come and do a compliance audit of your practice
Quite frankly if you have a compliance manual, program, officer or audit that resembles any of the above, it won't help you. Here's why: Compliance is not something that can be handled once and left to gather dust on a shelf. A compliance plan, no matter how much it costs or how comprehensive it seems, cannot make you compliant. In fact, you can have so many forms, agreements and paperwork for your patient to sign that you practically induce carpal tunnel syndrome – and you still may not be compliant. If this seems a bit contrary to the information you've swallowed about compliance thus far, allow me to make one simple, critical distinction.
Compliance: Not a Product or Paperwork
Despite what is being sold to most chiropractors, compliance is more of a process or system than a product or paperwork. In fact, to be truly effective (and compliant), chiropractors need a compliance system that is interactive, alive and most importantly, routinely referenced and utilized. That's why some lifeless binder or a bunch of agreements stuffed into a file cabinet won't cut it.
For example, for small-physician practices, the Office of Inspector General has issued a mandatory requirement for compliance programs that do the following:
- Conduct internal monitoring through periodic audits
- Implement compliance and practice standards through the development of written standards and procedures
- Designate a compliance officer or contact to enforce compliance efforts and practice standards
- Conduct appropriate training and education on practice standards and procedures
- Respond to detected offenses and develop corrective action
- Develop open lines of communication to keep practice updated regarding compliance activities
- Enforce disciplinary standards through well-publicized guidelines
The Limitations of a Static Compliance Manual
By now, you probably are seeing the limitations of that compliance manual you have sitting in some binder somewhere. Is it conducting audits to make sure that your billing and coding are going out correctly? Does your compliance plan have the ability to detect whether you have met the required components for billing the New Patient Exam codes that you utilize? And can it develop written procedures to ensure that the exam criteria are met by all the providers in your office?
How about claims submission? Are you exposing yourself to a payer audit by billing an incorrect code or unintentionally billing for procedures that were not performed? How is your compliance binder helping you detect and correct those mistakes?
Furthermore, are your compliance officer and staff adequately trained to fulfill their role in ensuring that everything in your office is conducted with compliance? Sure, they probably can hand out a HIPAA agreement along with the best in their field, but apart from having a patient sign here and there, are they assisting the doctor(s) in maintaining compliance or are they, in fact, a compliance hazard?
The Silver Lining in the Compliance Cloud
Most of the time, compliance is presented as a series of "thou shalt nots" and few people ever discuss the potential benefits of compliance. While the big upsides are certainly keeping your tail out of jail and avoiding fines and post-payment audits, there are actually several other good, profit-producing reasons for compliance. For example, a well-designed compliance program can:
- Speed and optimize the proper payment of claims
- Minimize billing mistakes that cause denials or payment delays
- Reduce the chances of an audit and post-payment demands
- Avoid potentially expensive conflicts with anti-kickback statutes or other regulations
- Provide insight and data about your practice patterns that may show opportunities for improvement
- Be a part of effective, comprehensive staff training that results in better employees
- Bring you peace of mind that you are doing everything right so you can sleep at night
Better Compliance = Better Business
If you've read this far, now you have a choice. Take a good, hard look at your current operations. If you have no compliance measures in place at all, your choice is pretty simple: Stay the way you are – and risk losing money and getting in trouble; or consider the above, and begin the journey to becoming compliant. If you now realize that your current compliance program, manual, forms or format are a bit lacking, you also have a choice: to get rid of your worthless compliance stuff giving you a false sense of security, and take steps toward implementing a real, interactive compliance system.
The downside of the way most chiropractors traditionally approach compliance should now be obvious. With this comes the realization that your outdated, unused compliance materials sitting in storage won't do you a bit of good because they lack one critical component – your usage.
The good news is this: Done right, most of the systems and procedures you will develop with respect to becoming more compliant will result in better care, better documentation, better billing, better coding, better staff training and yes – better compliance. And the by-product of all of these things should then be equally obvious: better business.
Editor's note: If you are having trouble deciding what to do, don't know where to start or would like some guidance, consider taking my 2 Minute Compliance Test, available free on my website at www.strategicdc.com/compliance. You may request a copy of the test by e-mailing me at info@strategicdc.com (please mention that you read this article).
