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There were a number of declarations at the end of each of the SBA loan applications that deal with compliance with various federal law such as civil rights laws, OSHA, HIPAA, etc..

Are you at risk for an Audit because you received an SBA loan or Federal Funds?

When the pandemic began, CMS Survey’s and Auditors were re-purposed to focus on infection control and compliance with regards to COVID-19 prevention. When you signed the SBA application and received funds, you attested that your practice is in full compliance with OSHA. Furthermore, when you received the Medicare Relief Funds, if you have used those funds, you attested to compliance with Medicare regulations.

It appears that CMS’s surveyors have gone back to the more typical fraud, waste and abuse audits, but they seem to be doing more audits than ever!

Therefore, if you don’t have preventative fraud, waste and abuse systems in place and policies & procedures, now is the time to take these requirements seriously and get compliant to avoid any retraction of funds received.  Just because you didn’t know the ‘rules’ doesn’t clear you from having to abide by them.

Even before COVID-19, Compliance Programs are required under the Affordable Care Act:

“Section 6401 of the Affordable Care Act states that a ‘provider of medical or other items or services or supplier … shall establish a compliance program as a condition of enrollment in Medicare, Medicaid, or CHIP. The OIG’s Compliance Program for Physicians and Small Practices (Outpatient Therapy Providers) as well as OSHA and HIPAA also require policies and procedures.

Amongst other things, compliance programs should assist you with the following:

  • Proper submission and payment of claims;
  • Reduction of aberrant or redundant billing & coding (which can help avoid fraud, waste and abuse);
  • Promotion and implementation of safety measures for all staff and patients;
  • Creation of HIPAA protocols to avoid breaches
  • Consistent disciplinarian action

Section 6401 of the ACA lists the following elements for an effective compliance program:

  1. Written Policies, Procedures
  2. Measuring Effectiveness
  3. Training and Education
  4. Opening the Lines of Communication
  5. Internal Auditing and Monitoring
  6. Enforcement of Policies and Procedures and Prompt Response to Compliance Issues. 

For a checklist for a compliance program content requirements that meets these regulations along with a turn-key solution, click here.

About BCMS

BCMS has been providing outpatient physical therapy compliance since 1996.  Our services include billing/coding/documentation consultation, off-site chart audits, comprehensive on-site audits, provider enrollment and credentialing but our marque product is our compliance program that covers all federal regulations mandated by the Department of Health & Human Services (HIPAA, Medicare/Medicaid, Fraud & Abuse, Non-discrimination) and the Department of Labor (OSHA, EEOC, ADA).  Here’s a quick  demo video.

To schedule time for a live demo, click here