Training Resources
Training Resources
It better. You might think you’re doing everything right – that your business is squeaky clean, but you can be assured that something is slipping through the cracks that would keep you up at night, unless you’re taking steps of prevention.
You’ve worked hard not only becoming a doctor, but in building your practice, and with a single unknown error, you could risk it all. Unknown? Guess what? That’s not a good enough excuse. You have to know. You need safe-guards, checks, and double-checks. You need audits of documentation and billing. You need patient signatures and you need solid records supporting the treatment you’ve provided to patients.And do you know ALL of the rules? State Practice Acts? Federal Laws? Do you have any idea what any of the multitude of PPO / HMO contracts that you’ve signed really say? Are you up on the most recent list of procedures that are bundled together?Here’s one you may not like. Have you invited outside audits? You can get outside firms to review and audit your records and billing for you to make sure you’re doing everything right. You can even invite the BCBS’s and Aetna’s of the world to come in and take a look.What about a written compliance plan? Where do you start? How about researching what other offices are getting in trouble for and making sure (and documenting) that you’re not doing those things? Do that one for sure.
Burying your head in the sand and hoping nobody sees you will never work. You need company policy telling everyone in your practice how you expect them to operate in compliance. And create a Compliance Officer position in your practice. Make this person 100% responsible for maintaining your compliance plan and for training all of the staff in compliance matters. Get a binder. That’s the easy part. Everything related to compliance goes there. Do your internal and external audits. File them in the binder.
Here’s one that’s huge: INTERVIEW YOUR STAFF. This should be a regular occurrence. Your staff knows all of the “secrets” that you don’t know yet. You have to find out everything that’s going on, investigate it, and and clean it all up. Reward people for information that keeps your practice out of trouble.
Compliance is a real and necessary part of any healthcare practice. It’s a tedious process that will keep you and your business out of trouble. You must avoid healthcare’s ultimate “F” word: Fraud.
Compliance Planning: It ain’t sexy but you need it like it is. – Chris Helms
Department of Labor worker’s compensation (OWCP) is a federal work injury program governed by FECA – Federal Employees Compensation Act. While not the same as Medicare, DOL is a federal program and should be treated accordingly. For doctors, the goal of DOL workers comp is to help the injured worker get better and back to work with the highest level of ethics and by understanding and following all rules and laws. The Department of Labor is generous to doctors who follow the rules and make the patient’s well-being their top priority. However, the consequences or poor business practices, bad business ethics, and misplaced priorities can be severe.
1. All Therapeutic Exercises, Therapeutic Activities, and Aquatic Exercises are 1-on-1. This means that every patient performing these exercises and activities will work directly with the licensed rehab staff 1-on-1.
2. 1 Unit of exercise = 15 minutes. 2 Units = 30 minutes. 3 Units = 45 minutes. 4 Units = 60 minutes. No exceptions.
3. The definition of 1-on-1 is 1 licensed staff member working with 1 patient at a time.
4. The MD / DO must evaluate all new DOL patients. All orders for therapy, DME, diagnostics, and outside evaluations must be made by and with the signature of the MD / DO. Schedule Award Impairment Ratings can only be done by the MD / DO.
5. A PA or NP can write reports and sign CA17’s and CA20’S, but all work by the mid-level must be countersigned by the MD / DO.
6. All physical therapy services must be done under the direct supervision of a MD, DO, DC, or PT. Billing for these services will be done using the licensed doctor / therapist who is onsite and who is supervising therapy.
7. Billing must always be accurate and always match documentation exactly. We will never bill for any services or supplies that were not actually provided to the patient.
8. Patients will always sign their documentation after it is complete, following the therapy being performed. Patient signatures confirm that treatment was performed exactly as it was billed and documented.
9. All services and supplies provided to patients will always be based on what is medically necessary for each individual patient. We will not provide anything to the patient that is not medically indicated.
10. We will follow all applicable state practice acts. Healthcare professionals (MD, DO, PA, NP, DC) will always practice according to their professional scopes of practice.
11. Rehab Personnel will follow the doctor’s prescriptions exactly. Rehab staff do not have the authority to change prescriptions for therapy. When changes are needed, they must be done under the authority and with the signature of the physician who wrote the therapy prescription.
12. We will take no kickbacks whatsoever.
13. We will follow all laws, rules, and regulations and require everyone we work with to do the same as a condition of doing business with us.
14. We will get legal opinions to support business decisions and ensure that we are always in compliance with all laws, rules, and regulations.
15. We will not be involved in bribery. All patients will come to us from legitimate sources. All work injury cases will be approved based on legitimate means and with strong documentation. All diagnosis expansions will be approved based on legitimate medical documentation, diagnostic testing, and actual patient need.
16. We will only treat patients with true work-related conditions. If a patient’s condition is determined or believed to not be work-related, we will not treat them under the Department of Labor or OWCP.
17. Duty Status Reports (CA-17) will only be done as needed when the patient’s work status changes. We will never bill for these reports just for the sake of billing. Changes in work status include a patient’s improved ability to work or decreased ability to work, patients being taken off work, or patients being sent back to work full duty.
18. We only take patients off work if it is medically necessary to do so. No patients are ever taken off work otherwise. Restrictions in work are based on medical evidence that indicates a patient’s reduced ability to perform their work duties at full capacity.
19. We will be a company that heavily emphasizes marketing. However, all marketing efforts will be legal. We will not provide kickbacks or bribes. We will aggressively pursue the attention of injured federal employees by all legal means available to us. We will not pay for referrals.
20. No unlicensed individuals will ever dictate treatment to doctors. This includes any unlicensed individuals who may be owners or partners in the practice / corporation.
21. We will perform quarterly audits of records and billings to ensure ongoing billing and record keeping compliance. Any errors or other problems will be documented, corrected, and reported.
22. Marketing personnel will be employees of the practice. No per-patient bonuses will ever be paid for marketing referrals. Marketers will be paid a standard rate regardless of patient volume or dollar volume from patients.
23. Marketing efforts are based on educating people who need help and who don’t know what to do when they are injured at work. We market through education. We teach federal employees, federal union leaders, supervisors, and other doctors about the federal workers comp system so they are better able to make informed choices regarding their work-related health issues.
24. Every office, including all staff members, should sign off in agreement with this compliance document as a foundation for holding the highest standards of business practice.
INFORMATION FOR COMPLIANT HEALTHCARE PRACTICES
The False Claims Act (also called the “Lincoln Law”) is an American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. It is the federal Government’s primary litigation tool in combating fraud against the Government.
(a) LIABILITY FOR CERTAIN ACTS.—
(1) IN GENERAL.—Subject to paragraph (2), any person who—
(A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;
(B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent;
(C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);
(D) has possession, custody, or control of property or money used, or to be used, by the Government and knowingly delivers, or causes to be delivered, less than all of that money or property;
(E) is authorized to make or deliver a document certifying receipt of property used, or to be used, by the Government and, intending to defraud the Government, makes or delivers the receipt without completely knowing that the information on the receipt is true;
(F) knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the Government, or a member of the Armed Forces, who lawfully may not sell or pledge property; or
(G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government,