Do you have a formal and effective compliance policy in place for your home health agency?

With increasing scrutiny of home health agencies, compliance is becoming one your biggest operational challenges.  Whether Medicare, Medicaid and private insurance your agency must be ready. Compliance is not strictly related to HIPAA but also regulatory compliance and in some states, very strict privacy laws.  Compliance is an all-encompassing strategy and operational tactic aimed at protecting yourself and your agency from fines and possible civil or criminal prosecution. 


The biggest and most critical compliance presence is home health regulation. Making sure your agency and staff is following all Medicare, Medicaid and private insurance rules and requirements really comes down to one thing, education.  Education of staff will go a long way in helping you stay away from the OIG, RAC auditors and state auditing contractors. While all three of these compliance authorities are using new analytical tools, following the basics can do quite a bit to make sure you stay out of trouble.


Analytical tools use the data you submit via OASIS and billing.  Your patient data is then analyzed using data sampling, data modeling and data mining methods.  A ton of data analysis occurs, but when you think about the amount of data as an agency you collect and process, it’s not too far of a reach.  As data analysis automation continues and the need to rid the healthcare system of fraud, you can expect more data mining and compliance issues to come up.  It’s best to prepare now and then adjust as necessary. 


Making one big change to your compliance program could be too late, and too difficult if staff is not willing to understand and become educated.  You only need to look at public companies such as LHC Group and Amedisys and the three year investigations that are still ongoing to understand the need for a comprehensive compliance policy. These guys had one too and it didn’t work! It goes further than Face to Face; it has to deal with billing, coding, referral source relationships and following the conditions of participation. 


The second most important part of you compliance plan deal with staffing and starts with an employee the moment she or he walks in your door.  Employment and payroll compliance is second biggest compliance areas in which agencies face potential legal traps.  


Following all local, state and federal employment policies is critical and can be difficult.  Setting up the systems to make sure you are in compliance all the time, takes effort and determination.  But this compliance is very much worth the effort.  With more scrutiny being placed on personnel files by state surveyors; do you really want to take the risk of having an avoidable deficiency smear your license? 


While compliance seems like it’s a very hard objective to meet, picking and choosing which rules and regulations you are going to follow is not acceptable or a good idea.  You need to follow all compliance policies and not hope and pray that you will be overlooked should something happen. To keep yourself and your agency safe, be one step ahead, not one step behind. 


Want to be compliant, but not sure where to start?  Email me, or give me a call!  Let’s have a stress free, casual conversation about how we can help you become compliant and stay compliant with the ever changing rules, regulations and laws.  Don’t wait!  Acting today could save thousands in fines, recouped payments and keeping your license clean.