Gaining From a Mandatory Compliance Program For Your Physician Practice

October 26, 2017

Section 6401(a) of the Patient Protection and Affordable Care Act, Obamacare, imposes a requirement — a mandatory requirement — that physician groups adopt compliance programs.

These programs are not simply plans that you document, toss into a notebook and keep on a shelf — they must be living, breathing programs revisited on an ongoing basis.

Undoubtedly, most medical groups will view their compliance efforts as completely divorced from their operational issues. Accordingly, in connection with their mandatory compliance program, they’ll in essence erect a wall between compliance and operations and proceed on each of those tracks independently.

But the better performing groups — those that I call the strategic groups — will use a different approach, Operational Compliance, in which compliance efforts are intertwined with a deep and thorough review of the group’s operations in order to address both the need to maintain an ongoing compliance program — that’s the risk management side — and to wring efficiency and profitability out of the group’s business — that’s the operational side.

Looking at this another way, traditional compliance work is generally viewed by medical groups as a “cost” — it’s money spent, well spent, managing risk, but it’s certainly seen as spent.

But in Operational Compliance, a significant portion of the funds devoted to the effort is an investment in identifying potential areas of profit: For example, the framework of your program can be used proactively to examine and optimize the billing and coding process, minimize billing mistakes, drive faster completion of billing materials and speed of the billing cycle, examine the efficiency of outsourced or in-house billing and collection operations, and examine options for post-billing service collections.

A compliance program also is a pivot point around which to design additional business relationships. In this light, compliance prohibitions are highly useful “negative guides” for what can be done.

The fact is that you have to have a compliance program. Do you want to have one that’s merely a “cost” incurred for the laudable reason of managing risk, or do you want go the rest of the way and leverage a portion of what’s already being spent into an investment providing operational ROI — return on investment — to your group — an upside over and above the simple management of risk?

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