Compliance certification is a strategic move. Medical office professionals who expand their compliance knowledge now will have the edge in today’s ever-changing health care climate.
Why You Need It
Each day that passes without an effective compliance plan increases your risk of staggering fines, penalties or even criminal liability if an auditor uncovers overpayments or alleged fraud. It is no longer a question of whether or not a practice will be audited by a third party, but when.
The evolution of health care is changing the way we handle patient records, write prescriptions, bill for services, work with physicians, hospitals and DMEs, etc. As if all of this weren’t stressful enough, the Office of the Inspector General (OIG) is watching and commanding total compliance with applicable rules and regulations.
Lack of knowledge won’t hold up in a federal audit.
Medicare and Medicaid have expanded audit contractor programs to squash fraud and waste. RAC/ZPIC or other contractors have been authorized by Medicare to come in to your office and request dozens, even hundreds of claims, with little notice and you must comply. Remember, even honest mistakes can trigger an audit.
Don’t be intimidated.
This is scary stuff, but for us, it’s a natural fit. We know this subject inside and out. PMI has spent 30 years teaching medical office professionals how to do it the right way. This program was carefully developed by leading compliance experts, Robert W. Liles and D.K. Everitt,CMCO, CCO. They teach this course in a way that you will understand, sharing real-world compliance examples relevant to your office. You’ll learn to handle tough situations with ease.
Is your organization prepared for greater accountability?
The OIG expects all health care organizations to be compliant with health care laws. This goes well beyond a paper document stuck in a file. It represents a functional, ongoing program with factors such as measuring effectiveness, proper training, review and update of policies and procedures. Your practice will be held accountable for new fraud and abuse risk areas that may arise as your organization becomes involved with new payment and delivery systems (such as medical homes, accountable care organizations, bundled payments, and value-based purchasing).
The severity of fines for false and fraudulent claims and kickbacks is staggering. As an example, the OIG has set the minimum settlement amount for violations of Self-Disclosure Protocol (SDP), under both the anti-kickback statute and the physician self-referral (“Stark”) law at $50,000 and up to three times the total remuneration.
Practice Management Institute’s Certified Professional Standards of Excellence were developed to promote ethical requirements and standards for its Certified Professionals. These guidelines were established and approved by the Practice Management Institute® Advisory Board for Certification Programming.
Standards of Conduct describe the actions that would reasonably be expected of a PMI Certified Professional in the performance of his/her duties. Certified Professionals are held to the highest professional standards in the medical industry. PMI Certified Professionals must agree to follow appropriate and legal guidelines according to governmental and third party payer organizations and contracts. They will support the compliance efforts and reporting system of the medical practice. They will bill only for services that are actually rendered. Services will be coded accurately and only when documentation is provided for the service. They agree to continue to learn and abide by current standards in the ever-changing business of medicine.
CMCO Roundtable Discussion
PMI presents a special five part series that explores the Certified Medical Compliance Officer program with moderator David Womack engaging in conversation with the creators of the program and CMCO graduates.
The Makings of the CMCO
D.K. Everitt and Robert Liles discuss the development and need of the Certified Medical Compliance Officer program.
Graduates share their experiences, their reasons for choosing the CMCO program, and their utilization of the information after completing the program.
Compliance Plan vs. Compliance Program
D.K. and Robert address the difference between a compliance plan and a compliance program as well as the risks of lacking a compliance program, and the chances of being targeted by auditors.
Compliance for the Medical Office - Part 1
Robert focuses on the importance of compliance to all parties in the medical office setting.
Medical Compliance for the Medical Office -Part 2
Robert addresses that compliance is the responsibility of everyone in the medical office.
Additional Support and Benefits
Graduates discuss how the program doesn't stop at the classroom.