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Building a compliance program. Guidelines for physician practices.

R Hart1, D Sheidy

  • 1Coopers & Lybrand, Harrisburg, PA 17101, USA.

Medical Group Management Journal
|February 6, 1998
PubMed
Summary
This summary is machine-generated.

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Physician practices face increasing federal scrutiny of billing in 1998. Implementing regular self-audits and robust compliance programs, particularly for CPT coding and specific billing scenarios, is crucial for avoiding investigations.

Area of Science:

  • Healthcare Administration
  • Medical Billing and Coding
  • Legal Compliance in Medicine

Background:

  • Federal investigations into physician billing practices are intensifying.
  • Maintaining compliance is essential for healthcare providers to avoid legal repercussions.

Purpose of the Study:

  • To advise healthcare practices on proactive measures to ensure compliance with federal billing regulations.
  • To highlight key areas of physician billing susceptible to intense scrutiny.

Main Methods:

  • Review of federal investigation trends in physician billing.
  • Identification of critical billing components requiring self-audits and compliance program focus.
  • Emphasis on physician liability for billing company actions.

Related Experiment Videos

Main Results:

  • Regular self-audits, especially of Current Procedural Terminology (CPT) coding, are vital.
  • Established compliance programs with dedicated officers are becoming standard practice.
  • Specific billing areas like "incident to" services, E/M codes (level 5, time-based), and split services require careful attention.

Conclusions:

  • Proactive compliance and diligent self-auditing are necessary to mitigate risks associated with federal billing investigations.
  • Physicians remain liable for false claims submitted by billing companies, regardless of knowledge.