Q: I understand that compliance programs are federally required, but like so many government mandates, you must ask: What are the benefits?
A:Many in long-term care view compliance programs with skepticism. The Affordable Care Act requires that organizations have written compliance programs, including ethical standards, policies and procedures reasonably capable of reducing criminal, civil and administrative violations and promoting quality care.
At a minimum, written policies must include the designation of appropriate compliance and ethics program contacts to whom individuals may report suspected violations, alternative methods to report anonymously without fear of retribution, and disciplinary standards. Surveyors can cite nursing homes for failure to have the required compliance and ethics program.
While complying with federal law is an important reason for developing and implementing a compliance program, there are other reasons why a program that goes beyond the minimum standards is worthwhile. If implemented effectively, a compliance program can:
• Help identify and fix problems early
• Demonstrate a commitment to integrity
• Mitigate penalties
• Improve claims submissions
• Identify coding concerns
• Reduce claim denials
• Improve medical record documentation
• Prevent resident care problems
It also is important to note that nursing homes operate in a very litigious environment. A thoughtful compliance program can reduce or prevent costly regulatory and civil claims. Though compliance programs do require time, effort and resources, an effective program will likely save you much more than it costs, while also increasing quality of care and resident satisfaction.
From the December 2023 Issue of McKnight's Long-Term Care News
