Medicare, Medicaid, HMOs, private insurance companies, as well as licensing agencies conduct compliance audits constantly. Typically these come in the form of billing/claim audits or state licensing/Medicare conditions of participation compliance surveys. However, the time to review your compliance is before your procedures and processes are examined by payors and licensing agencies.
KENNEDY recommends corporate compliance programs and periodic compliance audits in order to keep your agency from being caught up in the enforcement process. To that end, we work with consultants to perform “snapshot” audits which identify provider vulnerabilities, then create and install corporate compliance programs for health care providers.
Compliance Continuous Changes
Corporate compliance programs are required by CMS for some, but not all provider types at this point in time. As CMS and TMHP make changes in the guidelines mandatory corporate compliance programs may be just around the corner for many.