Harmony Healthcare Blog

Healthcare Corporate Compliance: Keys to Assembling A Sound Program

Posted by The Harmony Team on Tue, Apr 15, 2014


Edited by Kris Mastrangelo

A Corporate Compliance Program is the Long Term Care provider's formalized and proactive approach towards detecting fraud, abuse, and waste of precious company resources.  Exact regulations for this important program have not yet been crystallized, so many facilities are left wondering what, if anything, should be implemented immediately.  Harmony (HHI) recommends taking a hands-on approach to Corporate Compliance.  Although the impending regulations remain to be seen, a Corporate Compliance Program is of benefit to every facility.

Corporate Compliance in LTC has been getting a lot of attention lately, but it is certainly not a new topic.  As long ago as the year 2000, the Office of Inspector General (OIG) first published voluntary guidance on the topic.  In 2008 the OIG released a supplement to this publication that expanded the scope of their guidance and encouraged providers to form an effective compliance program with the single goal of improving quality of care and services.  Despite all the publicity about Corporate Compliance, and despite all the good reasons why a solid Corporate Compliance program should be built, for many providers it remains a mystery as to exactly how it should be implemented.

A Corporate Compliance program can be defined as a program that is a written and operational commitment to organization-wide compliance with all laws and ethical standards of behavior.  The structure of your Corporate Compliance program is not regulated.  But compliance with applicable laws is mandatory, whether you have a Corporate Compliance program in place or not.  A good Corporate Compliance program allows an organization to self-monitor operations on an ongoing basis to ensure and document compliance with applicable laws and adherence to the organization’s own policies and procedures.

The first step in implementing a corporate compliance program is to appoint a Corporate Compliance Officer.  The Officer should have the skills, experience and authority to implement the program.  The Compliance Officer will oversee the compliance program, including identifying the need for revisions to the program as the facility’s needs change.  The Officer will also coordinate and participate in training employees, and will independently investigate compliance matters and ensure that corrective action is taken. 

Once an Officer is selected, the organization will consider leaders from each department to determine and select who can serve on the Corporate Compliance Committee.  The Committee will be responsible for developing, operating and monitoring the compliance program.  The Committee will report directly to the organization’s owner, its governing body, and the CEO periodically and as needed.  In order to ensure that all compliance matters can be reported confidentially and without fear of reprisal, the Committee must establish an organizational reporting procedure.  The reporting process should encourage employees to ask questions and report concerns.

The Compliance Officer and Committee will examine current processes related to corporate compliance (including documentation and record keeping practices), and determine if current policies are adequate or need to be revised.  The goal is to assess the strengths and weaknesses of your organization's compliance process.  This frank assessment will determine how your organization needs to change to offer a safer and more efficient work environment.  This would include organization policies on HIPAA, fraud, kickbacks, resident rights and safety, quality of care, and other areas of compliance that affect your unique organization.  Record-keeping is an essential part of compliance as it serves as evidence of the organization’s quality medical care and accurate billing practices.  Medical documentation practices as well as billing documentation should be examined.  Also evaluated would be current policies and procedures that ensure patient privacy and the appropriate destruction of documentation that may contain sensitive or patient-identifying information.

Having completed this process of self-assessment, your team will assemble your corporate compliance documents and the policies that relate to corporate compliance.  These assembled documents will form the code of conduct for your organization.  This code of conduct is the expectation of behavior from all employees and contractors that work within your organization.  The code of conduct will be one of the elements of an employee’s annual evaluation.  As such, the Committee must ensure that all employees are made aware of the elements of the corporate compliance program.

The program will be rolled out to all staff with a public statement about the code of conduct and expectations regarding compliance with laws and ethical standards of behavior.  Education about corporate compliance will be part of your organization's annual competency process.  Proper and periodic training of managers, physicians, and staff at all levels is critical to ensure that all members of the team understand the governing principles of your corporate compliance document.  Employee evaluations would include if the employee promotes and adheres to the elements of the corporate compliance program.  An effective compliance program will also set forth consequences of non-adherence, including disciplinary processes and termination if the offense is especially egregious.

Your Corporate Compliance Committee will develop an internal auditing process to ensure that compliance is maintained.  Audits will occur throughout the year in determined at-risk areas, with the Committee determining the scheduling of the audits in each risk area.  Audits can be self-conducted, or conducted by an external evaluator with the necessary expertise in Federal and State requirements and private payer rules.  The Committee will report the results of the audits to the owner, governing body, and CEO.  The Committee will identify areas that are at risk and areas in which compliance can be advanced above and beyond the current plan, and will also work on revising the plan to stay abreast of current changes in regulation and practice standards.  The Committee will also assess current policies on the enforcement of standards, monitoring and auditing, and lines of communication to determine if they are adequate or require revision.

Some points that your Committee may manage are (but are not limited to):

  • Areas that have received repeat citations in annual survey.
  • A log that documents all complaints received and show that all complaints were promptly investigated.
  • Employee files must have evidence of background screening and professional license verification, and any other screenings required by your state.
  • A process for detecting and returning overpayments.
  • An anonymous way for employees to make complaints, such as a hotline.
  • Evidence that all employees know how to make anonymous complaints.
  • Evidence of a consistent discipline process for each violation.
  • Regularly scheduled audits to proactively identify problems.
  • Problems that have arisen frequently, in an effort to identify the root cause of the problem and prevent it from happening again.

Harmony (HHI) recommends that each LTC provider consider how they can best establish a Corporate Compliance Committee, and then begin the process of implementation.  Although impending regulations are not yet clear to providers, the process for establishing a Corporate Compliance Committee is.  More than just "paper compliance", the Corporate Compliance Committee will ensure that the organization meets its own expectations for quality care, keep abreast of new regulations to ensure compliance, and provide a powerful tool to prove compliance with industry regulations and professional conduct.

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Tags: Skilled Nursing Documentation, Corporate Compliance

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