What is OIG compliance guidance?

OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to …

What is the OIG model compliance plan?

Compliance plans offer the health care provider an opportunity to participate in a nationwide effort to reduce fraud and abuse in our national health care programs. The OIG believes that through a partnership with the private sector, significant reductions in fraud and abuse can be accomplished.

What are the seven steps or elements the OIG has determined must be present in compliance plans?

The 7 Key Elements of Compliance

• Written Policies and Procedures.
• Assign a Chief Compliance Officer.
• Education and Training.
• Open Lines of Communication.
• Discipline Policy and Actions.
• Internal or External Audits and Monitoring of Compliance.
• Response to Detected Deficiencies.

What is the role of OIG in healthcare?

Since its 1976 establishment, the Office of Inspector General (OIG) has been at the forefront of the Nation’s efforts to fight waste, fraud and abuse and to improving the efficiency of Medicare, Medicaid and more than 100 other Department of Health & Human Services (HHS) programs.

How many elements are included in the OIG model compliance guidance?

In developing an effective compliance program, the OIG has identified 7 fundamental elements.

What should a compliance plan include?

An effective compliance plan should include the following seven elements:

• Written policies and procedures.
• Designation of a compliance officer.
• Training and education.
• Effective communication.
• Internal monitoring and auditing.
• Employee discipline.
• Response to detected violations.

What are the components of an effective compliance program per the OIG?

Core Elements of an Effective Compliance Program

• Written policies and procedures.
• Designated compliance officer and compliance committee.
• Effective training and education.
• Effective lines of communication.
• Internal monitoring and auditing.
• Enforcement of standards through well-publicized disciplinary guidelines.

What are the steps in the compliance plan?

1. Identify Requirements/ Assess Risk. Identify Requirements/Assess Risk.
2. Establish/ Modify Compliance. Organization.
3. Document Standards, Policies, and. Procedures.
4. Communicate Standards, Policies, and Procedures.
5. Implement, Promote, and Enforce.
6. Monitor, Audit, and Report. Step 6: Monitor, Audit, and Report.

How do you determine compliance requirements?

Typical steps to achieve regulatory compliance include the following:

1. Identify applicable regulations. Determine which laws and compliance regulations apply to the company’s industry and operations.
2. Determine requirements.
3. Document compliance processes.
4. Monitor changes, and determine whether they apply.

How do you ensure compliance?

How to Ensure Compliance in the Workplace

1. Document any rules your employees need to follow.
2. Consistently apply those policies and procedures.
3. Take a positive approach instead of just saying “no”
4. Invest in employee training.
5. Use positive reinforcement for doing the right thing.
6. Keep employees engaged.

How do you ensure health care compliance?

5 Key Ways to Ensure Hospital Compliance Program Consistency

1. Create a multidisciplinary committee.
2. Write out policies, procedures, and schedules.
3. Perform internal audits.
4. Implement a robust education program.
5. Measure compliance program performance.

What is compliance criteria?

1. refers to a well-established correctness criterion for adaptive workflows that can be applied to check whether a running workflow instance is compliant with a changed workflow schema; i.e., whether the change is valid for the workflow instance.

What is compliance procedures?

What Is a Compliance Program? A compliance program is a company’s set of internal policies and procedures put into place in order to comply with laws, rules, and regulations or to uphold the business’s reputation.

The creation of compliance program guidances is a major initiative of the OIG in its effort to engage the private health care community in preventing the submission of erroneous claims and in combating fraudulent conduct.

What should be in a compliance plan?

A compliance plan should clearly indicate your commitment to proper coding, billing and documentation, to payor policies and all state and federal regulations, including HIPAA privacy rules concerning protected health information.