This is the second article of a multi-part series on the many dimensions of compliance related to diagnostic providers, independent device testing facilities (IDTFs), and hospital outreach laboratory services. The responsibility of compliance does not rest on the shoulders of one individual or committee. Compliance responsibility for laboratories, IDTFs, pathology practices, and hospital outreach programs must be part of every team member’s accountability, and collaboration on compliance helps manage risk and protect value.
The Spring 2021 Office of Inspector General (OIG) Semiannual Report to Congress stated that the OIG expected investigative recoveries for October 1, 2020, through March 31, 2021, to be approximately $1.37 billion and 221 criminal actions during this reporting period. OIG also took civil actions, such as assessing monetary penalties, against 272 individuals and entities, and excluded 1,036 individuals and entities from Federal health care programs. The massive recoveries by the federal government have resulted in continued aggressive enforcement and have encouraged state governments and commercial payors to take similar actions.
Compliance plays an essential role in the revenue cycle management (RCM) process for diagnostic companies and hospitals. As finance, billing, and RCM leaders review or update RCM processes, it is important to include compliance considerations. Compliance requirements keep changing, and a misstep can result in lost revenues, fines, and even extreme penalties like debarment, corporate integrity agreements, and criminal consequences for companies and responsible individuals. Thorough revenue cycle management addresses compliance issues that can otherwise cost an organization money, business freedom, and even exit opportunities.
To maintain an effective compliance program, abide by applicable law, and as a necessary risk management approach, there are seven factors that together comprise an effective compliance program.
Providers’ revenue management activities need to include compliance planning and monitoring. The hot issues of the day change and appropriate attention will enhance the likelihood of keeping the revenue the organization earns and preserving the value the organization creates.
The healthcare industry is in a state of constant change in laws, regulations, government requirements, reimbursements and payor requirements, and commercial and patient expectations. It is hard for any individual diagnostic provider to keep up with the changes. An effective compliance program is essential. To learn more about how XIFIN helps customers reduce their compliance risk, visit the Compliance page on our website.