Final physician guidance answers key concerns
Final physician guidance answers key concerns
The final compliance plan for individual and small group practices released by the Department of Health and Human Services’ Office of Inspector General (OIG) Oct. 2 answers most but not all of the concerns raised by providers when the draft plan was published last June. The Englewood, CO-based Medical Group Management Association (MGMA) says the guidance is now "more realistic and doable," especially for practices that lack the extensive resources required to establish formal compliance programs.
"The final [version] is more flexible than the draft in that a lot of the should’ language has been replaced with may’ language," says health care attorney William Saraille of Washington, DC-based Arent Fox.
But not every concern has been answered, Saraille adds. For example, he says the OIG did not respond to concerns regarding the definition of small practice. However, MGMA spokesman Aaron Krupp says that determining whether
to make that assessment on the basis of employees, revenues or specialty would be no easy task.
Saraille also credits the OIG for trying to "operationalize" the guidance and offer practical advice about what steps should be taken and in what order, even though he says it is somewhat inflexible about what those steps should be.
For example, he notes the OIG suggests an internal audit as the first step. However, small practices and solo practitioners might benefit more from training that helped show where some of their associations may not be accurate.
Kimberly Brandt, senior counsel for OIG, emphasizes many of the same points regarding the final guidance. "It is voluntary," Brandt emphasizes. "It is not mandatory. It is optional, and it is at your discretion."
She contends that there was a "misperception" among physicians that the guidance was mandatory and there was a specific time frame under which they had to implement the various components.
Brandt zeroes in on three key features of the guidance. First, it is "very flexible," she says. It includes numerous options not only for how you implement the various components but whether they are implemented at all. "There is also an emphasis on the difference between errors vs. fraud," she asserts. "Lastly, there is an emphasis on the active application of compliance principles as opposed to having the formal process of compliance in place."
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