As a member of the home care industry, it can often seem as though things are always in flux. If you are a Medicaid home care provider, that statement is even more accurate. In January, the Centers for Medicare & Medicaid Services (CMS) announced a second temporary moratorium on the enrollment of home health agencies in the Medicare Program, Medicaid Program and Children’s Health Insurance Program, with the first announced last July.
According to CMS Administrator Marilyn Tavenner, “Our first use of the moratoria put fraudsters on notice that we are using all available tools, including these moratoria, to combat fraud, waste and abuse in our health care programs, while maintaining patients’ access to care. Today’s announcement shows we are continuing our intense fight against fraud, waste and abuse in these vital health care programs.”
With all the changes taking place within the industry, it’s a good time to consider giving your compliance strategy a checkup. Under the health reform law, home health agencies nationwide will soon be required to take a preemptive approach to preventing fraud, waste, and abuse by adopting compliance and ethics programs. The law requires that these compliance programs be reasonably designed, implemented, and enforced so that they will effectively prevent and detect criminal, civil, and administrative violations while promoting quality of care.
According to CMS, your agency’s compliance program must also contain the following components:
- Compliance standards and procedures
- Assigned personnel responsible for overseeing compliance
- Steps for effective communication of compliance standards and procedures to employees, including procedural training
- Monitoring and auditing systems for detecting criminal, civil, and administrative violations
- Established procedures to respond to detected violations
- Periodic reassessments
It’s essential for an effective compliance program to also include clear policies regarding disciplinary action for managers, employees, and other professionals who fail to comply with the agency’s compliance measures, and consistent enforcement is imperative. Ideally, the goal for your compliance strategy should be to create a culture of compliance and ethical conduct that promotes prevention and protects your agency against fraud.
Home care compliance is an important and ever-evolving process that is necessary to prevent fraud and abuse within the system. When agencies that are supported by government reimbursements do not have or adhere to a comprehensive compliance program, they can incur heavy fines and even risk being dropped from payers such as Medicaid. Through implementation of an effective program now, your agency will be better equipped when mandates are in place.
Arrow Solutions’ Eligibility Verification System can be a helpful part of your compliance strategy. With our system, the Arrow team can initiate an inquiry for eligibility for Medicaid patients via a member identification number, interpret the response that comes back from the payer, and alert your agency when a change occurs so you can be sure you are billing based on current and compliant information every time.
Contact Arrow Solutions today to learn more about our unique home care software system and standalone products that can help you stay compliant and increase efficiencies across your agency.