Each provider or organization not only has to follow the law, but they must become their own policeman and create a culture of compliance among all their employees. This has become mandatory with the Health Care Bill signed by President Obama in 2010. But compliance does not mean just record-keeping. It also means administrative, financial, and regulatory adherence to the regulations. Each organization, big or small, will increasingly have to become extremely aggressive in auditing its own processes, records, and data and respond appropriately.
Hospitals can pay millions of dollars in fines if they fail Recovery Audit Contractor (RAC) audits. Health Maintenance Organizations (HMOs) will see a drastic cut in funding if their Star Ratings are low. The Office of Inspector General (OIG) has targeted practices with high Medicare Risk Adjustment (MRA) for its audits. Thus, it will be incumbent upon the practices that are more successful in documenting well and billing high to carefully screen their billing and coding within their own organization before their encounters are sent out.
Education and continuous training of Human Resources and improved tools should make organizations compliant, and intolerance of fraud or abuse will require investment from small and big practices to satisfy State and Federal Regulations in the near future. Internal auditors and comprehensive compliance plan should be discussed with executives and passed to every employee. The hope is that this will empower them to be accountable to achieve a standard goal within solo practices and multi-billionaire organizations.