OMA Newsletter

Best Practice Newsletter - Spring 2013

Compliance Corner:
Effective Training and Education Programs are Crucial Component in Compliance Planning


Because the federal government has the authority to investigate every medical claim, physician practices should ensure that each employee adheres to the specific federal requirements by providing effective training and education programs. By establishing and implementing a compliance plan that includes a routine training and education process, physician practices and organizations proactively address federal fraud enforcement and reinforce the practice’s commitment to adhering to federal requirements – all of which protects the practice from scrutiny should an error occur.

A variety of techniques and materials may be used to educate employees about the practice’s compliance plan, and educational activities should be conducted on a regular basis, with frequency of participation dictated by an individual's function in the organization.

Effective education and training programs focusing on compliance with fraud and abuse laws should include an overview of the related laws, the operation and importance of the compliance plan, and the role of each employee in the compliance plan. For individuals who will have direct involvement with aspects of an organization's operations where there is a significant potential for application of the health care fraud and abuse laws, extensive education specific to the individual's responsibilities is recommended.

For example, physicians should understand their responsibility to provide appropriate medical record documentation of the care provided. Both physicians and billing staff must understand their responsibility to ensure billing records conform to the documentation found in the medical record.

Organizations should maintain a record of both its training activities and individual participation in these activities, as documenting the practice’s compliance plan training programs is beneficial if an inadvertent error occurs.

Through participation in the Barnabas Health Office Managers Association (OMA), members have access to a number of workshops and seminars, including those on legal issues and CPT and ICD-10 updates, which help to meet educational requirements in compliance plans.

Source: American Medical Association.