From the Physician's Corner

Some Considerations on Office Compliance

By Henry Tulgan, M.D. FACP

When physicians open the doors of their offices for business every day, the vast majority don’t think about the substantial number of both state and federal regulations that apply to them. Some are common to all lines of business, such as federal OSHA (Occupational Safety and Health Administration) ones.
Many more are specific to our profession: those include the federal ones promulgated under HIPAA (Health Insurance Portability and Accountability Act), the CDC (Centers for Disease Control) and CMS (Centers for Medicare and Medicaid Services).

However, the regulations for billing, coding, record keeping and insurance fraud may not immediately come to mind.  Nor may we realize that we may need to obtain informed consent and document translator services when they are required in certain circumstances.  As practices increasingly employ more nurse practitioners, physician assistants and others, it is mandatory to know just what functions they may be allowed to or licensed to perform. A complete background check on all employees, particularly when initiating employment, will ensure that no previous legal violations have occurred.

Also, patient care issues may include the necessity to document incoming telephone calls and timely returns of those calls, the importance that records be legible and that prompt physician review of all ordered lab or other diagnostic studies be documented.  In addition, boundary violations, such as improperly touching a patient, must be addressed and avoided.  The consequences for failing to comply with rules and regulations can be serious. Improper coding and billing may carry not only financial penalties but may even lead a physician to lose his or her license. There are a number of proprietary companies available to assist physician practices in developing compliance plans, and skilled attorneys and accountants may also serve as advisors.  Physicians are already familiar with policy and procedure manuals in hospitals and developing them for our offices.  It is essential to periodically review these manuals with members of our staff and update them as new regulations are passed. After all, it’s a form of “preventive medicine.”

Risk Management Strategies

• Start with setting up systems to bring high-risk areas into compliance – such as Medicare, Medicaid and insurance billing – before expanding to other areas.
• Have systems in place and provide staff training for compliance in the following areas:
  • Accurate billing and coding
  • Delegating care to staff members
  • Following up with patients
  • Documenting phone calls
  • Keeping readable records
• Document informed consent, making sure that a patient was fully aware and making a decision to consent to a procedure. The informed consent must show that it was presented in the patient’s language. (For example, an English form should not be presented to a Spanish-speaking person.)
• Be aware of boundary violations such as improper touching or revealing your personal life.

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