Physician compliance plan gets qualified ‘thumbs up’
Physician compliance plan gets qualified thumbs up’
Health care provider groups and attorneys say the Department of Health and Human Services’ (HHS) Office of Inspector General’s (OIG) 43-page draft compliance plan for physicians in solo or small group practices released June 7 is mostly good news for doctors, even though most of them were not eager to have such a plan in the first place. (See Compliance Hotline’s special fax bulletin, June 8.)
Aaron Krupp of the Englewood, CO-based Medical Group Management Association (MGMA) says his group — which represents mostly small practices — is relieved, but not overjoyed. "We have mixed opinions about it," he reports. "We are very pleased the OIG attempted to make the guidance flexible, but we still have concerns."
The OIG initiated the process last year by soliciting comments from physicians on what a compliance program should look like, as well as their overall level of interest. OIG General Counsel Mac Thornton said 83 comments were submitted in all, which encouraged his office to go ahead with the plan.
According to Krupp, most of the concerns harbored by MGMA center around whether small practices will have the resources required to implement all of the measures the OIG includes in the draft guidance. For example, Krupp says his group was concerned about the requirement included in the OIG’s initial notice that each practice establish an 800-number. "A lot of practices clearly don’t have the resources to establish something like that," he explains. But he says his group was encouraged by the OIG’s decision to let an "open-door" policy satisfy that requirement.
However, Krupp says his group is still concerned about the OIG’s requirement that practices maintain a current compilation of relevant regulations. In releasing the draft plan, Thornton highlighted that as a key task for practices. "That can place a tremendous burden on practices," warns Krupp. "It is hard enough for us to stay on top of all these regulations and understand them."
In addition, Krupp points out that while the guidance is not mandatory, the draft repeatedly refers to "essential" ingredients of an effective compliance program. "That sends a bit of a conflicted message," he argues. "That is why we were wary about this in the first place."
Yet another concern for Krupp is the lack of any definition about what constitutes "an individual or small group practice" covered by the plan. "You would think that they would have to clarify what constitutes a small group practice," he asserts. "But they don’t." Thornton says the OIG deliberately left that vague in order not to set an artificial boundary that appeared to exclude certain physicians.
Health care attorney Julia Krebs-Markrich of Washington, DC-based Reed Smith also sees the draft plan as mostly good news. "What they are saying here is not unreasonable," she argues. For example, she notes, the OIG details what should be included in a periodic audit.
"I thought the first appendix regarding additional risk areas was also very helpful," she says. That section points out what physicians must do to comply with local medical policy reviews. "It also addresses professional courtesy and clarifies some of the concerns that have been raised about physicians extending professional courtesy to patients," says Krebs-Markrich.
The plan also addresses third-party billing services. "There has been some noise over the past few years about using a billing service where the physician pays the billing company on a percentage basis," says Krebs-Markrich. She says the draft plan offers useful clarification in that area by explaining that a physician may contract with a billing service on a percentage basis, but while highlighting practices that would raise problems.
"There is a degree of specificity here that has not been present before that is very helpful," she concludes. "I think they have tried very hard to be helpful."
The guidance, which also covers dentists, chiropractors, and others, is likely to be the last major compliance plan that emerges from the OIG, according to Thornton, who said physicians can expect to see a final plan early this fall.
The OIG’s Compliance Program Guidance for Individual and Small Group Physician Practices was published in the Federal Register June 12, and carries an extended 45-day comment period. It is available on the OIG’s Web site at http://www.hhs.gov/oig/new.html.
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