Medical Billing Compliance

In the medical billing industry, all parties have compliance responsibilities. Any provider dealing with Medicare and/or Medicaid has mandated compliance responsibilities from OIG and others, plus an ACA requirement for a formal compliance plan. The OIG Compliance Program Guidance for Third-Party Medical Billing Companies forms the basis for the AdvantEdge compliance plan. AdvantEdge has always treated compliance as an integral part of the coding and billing process. Every employee takes a comprehensive compliance course at least once a year and AdvantEdge endorses and fosters a culture of compliance in all phases of company operations. The goal is for each client to obtain the full reimbursement to which they are legally and ethically entitled,  in a manner that fully complies with both the letter and the spirit of all applicable regulations and guidelines.

Compliance Services

In addition to the compliance “built-in” to other AdvantEdge services, the company offers physician groups and hospitals a menu of compliance services to augment their internal compliance resources while energizing their compliance program. Each is designed to deliver one or more key components of a compliance program with a minimum of administrative work by the practice or hospital. The services include:

• Compliance Plan and Program Review
• Compliance Training
• Compliance Hotline
• Compliance Alerts
• Compliance Q&A
• Compliance Incident Support
• Compliance Plan Development

 

Call 877 501-1611 today to learn more about how AdvantEdge can substantially reduce the risks faced by your practice or hospital.

Compliance Program Review

It’s not uncommon for a Compliance Program to become stale. In other cases, physicians or administrators may be concerned about whether the program is current with the latest regulations. In these and similar situations, the solution is easy: a formal review by AdvantEdge compliance experts. They will inspect the program including how it is implemented across your organization and provide a formal report with findings and recommendations. The typical timeframe is two to six weeks, depending on the size of the organization.

Compliance Training

One of the hardest things to implement in a compliance program is ongoing training for providers and others in the organization. Training in HIPAA Privacy and Security is particularly important given the everyday risks associated with PHI (Protected Health Information). For regular training and updates, AdvantEdge offers a cost-effective online package that each team member can complete at the time most convenient for them. It includes interactive multimedia presentations that engage viewers and make them a part of the learning process. Packages are available in a variety of sizes to accommodate organizations of all sizes.

In some situations, your group may need training on a specific topic or process. AdvantEdge offers customized courses on a one-time and a recurring basis. For recurring courses, or where a large number of providers and staff need to be trained, the course can be delivered cost-effectively via LearningEdge: the AdvantEdge online learning management system.

Compliance Hotline

It is strongly recommended that physician groups and hospitals offer a hotline for employees to report compliance concerns and questions, on an anonymous basis if they wish. AdvantEdge offers a toll-free Compliance Hotline directly to our compliance office who will record the inquiry and followup with your compliance officer, as appropriate. Having a third party provide this service helps assure employees of their privacy thereby encouraging more reports. It is worth noting that AdvantEdge experience shows that most Compliance Hotline calls do not identify serious problems but they often do identify areas where education is required.

Compliance Alerts

One of the biggest challenges for any healthcare organization today is staying current with the barrage of regulations as they are continually updated. With this inexpensive service, AdvantEdge clients are notified via email immediately whenever an important regulation or rule is updated or changed.

Compliance Q&A

Many Compliance Officers find themselves faced with new or unique situations on a regular basis. Sometimes the answers can be found online or via colleagues. But often a compliance expert must be consulted. AdvantEdge offers exactly this capability: access to the AdvantEdge compliance office and experts. As required, they will research your issue and provide a recommended solution. Think of them as an extension of your compliance team.

Compliance Incident Support

When a potential compliance incident is identified, it is critical that the organization have a defined process in place to respond, effectively and timely. Since incidents should occur infrequently, it can be hard for an organization to have the necessary expertise in place. AdvantEdge offers this service as an extension of your compliance office.

Compliance Plan Development

For organizations that do not have a compliance plan or program in place, or where an entirely new plan is warranted, AdvantEdge will assign its compliance experts to work with you to develop a plan appropriate for, and tailored to, your organization.

The AdvantEdge Compliance Program

The Compliance Program is led by the Compliance and Privacy Officer, who is an experienced member of senior management. The program has been designed using guidelines from the Compliance Program Guidance for Third-Party Medical Billing Companies issued by the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), HIPAA Administrative Simplification, and ASA. As guidelines evolve and new ones emerge, the AdvantEdge Compliance Program stays current. The Compliance Officer and staff members, including each Certified Professional Coder, regularly participate in seminars on compliance matters in order to stay abreast of developments and interpretations.

 

AdvantEdge clients are secure in the knowledge that the Compliance Program, the Compliance Manual, employee training and the company’s Code of Conduct — which follows OIG guidelines — are in place and followed, resulting in an overall culture of compliance.

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