Regulatory compliance for a medical practice is a necessary component of patient care. These guidelines create outlines for a practice to follow as part of its operational process and avoid medical compliance pitfalls. However, many medical practices are found to fall short of expectations when it comes to adhering to compliance protocols.
Medical Practice Compliance Pitfalls
A few common observations when it comes to being compliant while avoiding medical compliance pitfalls are as follows:
Insufficient Resources
A cut in overall budget allocations, staff recruitment, and technology spending can hamper the execution and implementation of a robust compliance program. One must note that compliance resources need to include the time and effort of the compliance team as well as that of the proprietors and senior management.
An allocation of adequate resources helps the practice to ensure proper training for the team and empowers it to understand more about the impact of compliance.
No adequate leadership support
It is often said that compliance starts at the top. The management needs to set the tone and the culture for the practice or healthcare provider for compliance processes to be adhered to.
Dedicated compliance efforts supported by the leadership can help the organization to remain compliant. The leadership along with the staff need to garner a proper understanding of what the compliance needs are.
A dedicated Compliance Officer not appointed by the practice
At times, a dental practice or healthcare provider may brush aside the need to appoint a dedicated compliance officer or a compliance team.
Keeping a qualified member within the dental team to manage compliance tasks can drive accountability while ensuring proactive management of compliance-related activities. The appointed compliance officer needs to be always aware of evolving guidelines, regulations, and updates. This aids the practice to stay compliant.
Absence of Policies and Procedures
A dependence on manual processes can lead to a lack of accountability. Compliance documents may not be accessible to all and might be available in different versions if processes are not strictly followed and adhered to by the practice.
This can also hamper the development of comprehensive policies and procedures. Policies must be readily available to all staff. The practice needs to ensure that policies and guidelines are well understood to avoid the risk of non-compliance.
No rigid documentation in the billing
If documentation is incomplete or haphazard, it can trigger an argument or discussion about a procedure or solution that might not have been medically necessary from an
auditor’s perspective. If a patient needs to be admitted to the hospital, the practice must justify such a decision. The practice needs to comprehend what Medicare needs to be documented in the records. This helps validate CPT codes in billing.
Cutting and pasting in electronic medical records, also called cloning is regarded as a misrepresentation of a medical necessity requirement for coverage. This needs to be avoided before it gets spotted by auditors.
Lack of adequate reporting or investigation into incidents
Many practices fail to report and investigate incidents. This is a mistake and must be rectified as soon as possible. Dental and medical practices need to build a culture and process of incident reporting. The team needs to report any untoward events or patient complaints regularly and promptly.
The practice needs to empower the compliance team to deploy effective incident investigation procedures. The team needs to detect root causes, undertake corrective actions, and avoid possible such occurrences from happening again.
Policies alone do not make a practice stay compliant
Sometimes a practice can purchase off-the-shelf policies at the beginning. It is possible that these policies may not be periodically reviewed. These packages are meaningless if the practice does not ensure that there is proper training or implementation alongside.
In a digital era, sometimes sending an image or not having adequate cybersecurity frameworks can create a security lapse. At the time of an audit, a practice can discover shortfalls in privacy or security. The practice can be slapped with steep fines in such cases. It is recommended to have a robust compliance plan and ensure a periodic security audit is performed. The team also needs to be trained about such policies and packages.
A practice needs to take cognizance of some common compliance challenges that will enable it to handle compliance audits and more importantly, address concerns that can result in issues that result in non-satisfactory patient experiences. A medical practice must instill a robust compliance regime that will help improve financial health and a growing base of satisfied patients.
