Compliance continues to be an area of extreme focus for the healthcare industry, including the care continuum. Where healthcare compliance professionals spend their time is changing as accrediting bodies and regulators find new areas that merit investigation. Healthcare’s low operating margins and tenuous financial health make it easy to say that compliance leaders need to split their attention between traditional activities and the where the future is headed.
In our efforts to identify new compliance directions, content experts from HCCS, A HealthStream Company, recently attended the Health Care Compliance Association’s 2018 Enforcement Conference. We’ve already blogged here about the first round of things they learned. Here is an excerpt from Round 2:
Enforcement Compliance: Home Health, Hospice, and Nursing Homes
Federal and state governments continue their close scrutiny of the post-acute sector. Listed below are the targeted areas discussed during this session:
Compliance Risk Areas for the Care Continuum
Risk areas within this space remain fairly consistent with medical necessity, kickbacks and inappropriate referrals, overbilling, insufficient documentation, staff training and education, credentialing and exclusions accounting for the major findings. Inappropriate billing accounted for $250 million for general inpatient care. The OIG Office of Audit Services is now auditing agencies and intends to publish findings. This will increase transparency for consumers when looking for facilities. Medicare Administrative Contractors (MACs) are now required to prepare an annual “Improper Payment Reduction Strategy.” The intent of this program is to identify those providers who show a pattern of overbilling and provide education and training in an effort to reduce occurrences. The MACs will analyze data by providers, services, and beneficiaries. Focus audits will be initiated based on this data. This action is mandated under the Affordable Care Act and as a part of the Medicare Strike Force initiative.
CIAs and Non-Hospital Healthcare
This session also addressed Corporate Integrity Agreements (CIAs) in the post-acute/continuum environment. The requirements for compliance are essentially the same as for the acute care sector. Although the presenters did touch on the financial, operational, clinical, and compliance costs in some detail, they focused on the impact of hiring and retaining an Independent Review Organization throughout the term of the CIA. These are all important considerations for organizations as they perform at a minimum, annual risk assessments. Along with the focus on the post-acute space comes the criminal aspect of healthcare fraud.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.View All Learning & Performance
When you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.View All Quality & Compliance
Fulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.View All Products
HealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.View All Reimbursement
Improve the preparedness of your staff, increase survival rates, and cut costs with the advanced resuscitation training services from HealthStream.View All Resuscitation
Expand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.View All Clinical Development
Delivers everything you need to request, gather, and validate information about a provider to create a single source of truth for downstream processes.View All Credentialing
Make sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.View All Scheduling & Capacity Management