Element #2-Compliance Policy and Procedures

So we chose our corporate compliance officer, we determined whose on the compliance committee and we are all set to rock and roll with our compliance program. Now what?

Let’s take a look and the next element of the OIG compliance program, Compliance Policy and Procedures.

Compliance Policy and Procedures:

Now your thinking- please noooooo! I have a stack of policies in my office that are taller than my son on the high school basketball team!! Let start at the beginning. The first thing we need to look at is do we have a Code of Conduct. What is a code of conduct? Think of it as the facilities constitution- it’s a document that expresses the fundamental principles of the organization- how we expect our employees to conduct themselves, the facility philosophy, what is a breach in compliance and how is it reported.

The facility Code of Conduct should be short, easy to read and accessible to all staff. It needs to be regularly reviewed by the board of director and all employees must review. The OIG recommends that even a small nursing facility should “obtain written attestation from its employees to confirm their understanding and commitment to the nursing facilities code of conduct.” Its best practice to do this at hires, yearly and if there are revisions to the code of conduct.

Just as a memory jogger- policies are clear statement of rules the employees are to follow and procedures are methods used to put policies in to action day-to-day. The OIG recognizes that most facilities have comprehensive policy and procedure manuals and that most facilities have in place procedures to prevent fraud and abuse. You may not need to develop a new set of policies as part of your compliance program if your existing policies effectively cover operations and relevant rules. Be sure your policy and procedures are reflecting the most current regulations and address your facility’s assessed risk areas

What are some high risk areas? The OIG provided a preliminary area of risk including quality of care and residents rights, employee screening, vendor relationships, billing and cost reporting, and record keeping and documentation. What are some specific areas you may want to explore?

· Billing

· Compliance hotline

· Compliance reporting / investigation

· Conflict of Interest

· Medical Director contracts

· Cost reporting

· Discrimination against residents and payment provisions

· Employee Screening

· False claims Act

· Gifts

· Marketing practices

· Medicare- Prospective Payment systems

· Non- retaliation/ Non- retribution

· Overpayment reporting

· Rehab services

· Resident Inducements

· Resident referrals

The objective of this assessment should be to ensure that your employees, managers and directors are aware of these risk areas and that steps are taken to minimize, to the extent possible, the types of problems identified. The first step is to identify and then be sure there are sound policy and procedures to ensure compliance.

It’s super important for your organization to understand the risk areas in YOUR facility. For example, are you reviewing your annual survey and updating your policies based on the deficiencies? Are the concerns of the compliance committee reflected in policy review? Are policies and procedures reflecting the trends noted in your data analysis?

Questions to ask yourself?

1) Do essential compliance policies and procedures exist?

2) What do we do as a facility to regularly review and update policy?

3) How to we ensure that are policies are relevant and effective?

4) How is staff notified of changes in policy?

5) What mechanism does the Compliance Officer have to review data/trends to ensure that we are being proactive in our risk assessment?

On to the next element- tackling effective lines of communication!