Run Your Practice More Efficiently
Are you compliant with ACA’s mandate for Corporate Compliance?
The regulatory environment for practices is becoming increasingly more complicated. Many practices do not have updated HIPAA Privacy and Security Plans, and few have ongoing Corporate Compliance Plans. We can help you identify your risk areas and create solutions that meet your Corporate Compliance needs.
NYS Required Compliance Program
As your Billing Company we want to ensure that you are aware that you are required to have a comprehensive compliance program in place, if you meet one or more of the criteria below. If you answer YES to any of the following questions below you are required by New York State to have a compliance program in place in your office:
- Does your organization receive Medicaid or Medicaid Advantage payments—and/or will be reasonably expected to receive these Payments—either directly or indirectly, of at least $500,000 in any consecutive 12-month period? Indirect Medicaid reimbursement is any payment that you receive for the delivery of Medicaid care, services, or supplies that comes from a source other than the State of New York. For example, if you provide covered services to a Medicaid beneficiary who is enrolled in a Medicaid Managed Care Plan, the payment you receive from the Managed Care Organization is considered an indirect payment.
- Is your organization subject to Article 28 or Article 36 of the NYS Public Health Law (PBH)?
- Is your organization subject to Article 16 or Article 31 of the NYS Mental Hygiene Law?
- Notwithstanding the provisions of § 4414 of the NYS PBH, is your organization a managed care provider, as defined in SOS § 364-j, which includes managed long-term care plans?
A compliance program must be specific to each practice and must include the following eight elements:
Element 1: Written Policies and Procedures
Element 2: A designated employee vested with responsibility
Element 3: Training and Education provided to all staff
Element 4: Open Lines of communication to the responsible compliance position
Element 5: Disciplinary policies to encourage good faith participation
Element 6: A system for routine identification of compliance risk areas
Element 7: A system for responding to compliance issues
Element 8: A policy of non-intimidation and non-retaliation
MIPS: We can help you avoid financial penalties from not participating:
- Make the transition from Meaningful Use to MIPS and make sure you continue to meet the required benchmarks
- Ensure that there is accurate and clear documentation in case of an audit
- Provide training on the tougher measures
- Navigate upcoming changes to the Program