Developing practical billing procedures for compliance.

Abstract

An effective compliance plan can be a mitigating factor should an agency face fraud and abuse charges. The goal of establishing specific procedures to ensure accurate and appropriate billing practices not only demonstrates the agency's position regarding fraud and abuse, but also eliminates waste and provides better quality care to patients. The procedures necessary to ensure that an agency is billing only for medically necessary services that have actually been provided in accordance with a physician's order encompass most of the agency's clinical and financial operations. By concentrating on these areas, the majority of compliance issues are addressed while providing the added benefit of the availability of more accurate data for analysis and monitoring.