In this era of heavy regulation, it’s mandatory that medical practices have a compliance program, and the back bone of every compliance plan is a Code of Conduct. The Code is a written set of principles that is used to guide decisions and behaviors within the office. Simply put, it’s a set of rules governing responsibilities and proper practices; it’s the standard of ethics the practice owners pass down to every employee in the office.
There are typically four sections in a Code of Conduct:
- introduction
- intent
- rules
- implementation and sanctions
The introduction conveys the leadership’s goals and intentions. The intent typically shares what the practice is all about, what it does and why it exists. The rules define standards expected of conduct for the practice as a whole and for each employee individually. Finally, the implementation and sanctions deal with the administrative side of the business. When employees are involved in violations and do not live up to the standards set forth by the leadership, set consequences are administered.
The Office of Inspector General (OIG) expects all healthcare organizations to develop and adhere to a set of standards known as a Code of Conduct. Experts agree that an effective code must be informative and have straight forward written standards. The code doesn’t need to be complicated; it should be written with simple language that is easy to read and should set forth clear, understandable expectations.
You can create, adopt, or even buy a code of conduct. There are many examples on the internet to use as a guide. The government’s overall goal here is to have ethical medical practices. With all the estimated fraud within Medicare and Medicaid and their budget shortages, our government is trying to tackle healthcare fraud on all fronts. The incidence of fraudulent activity is smaller in offices that operate under ethical standards governed by a formal Code of Conduct. From a taxpayer’s point of view, it’s worth a little effort on the part of providers to help prevent $60 - $100 billion in fraud per year. Everyone looks to providers and healthcare organizations to help, and it’s easy to make a beginning by designing a Code of Conduct that makes sense for your practice.
Medical Billing Resources provides a wide range of compliance policies and program guidelines free of charge to its clients. We invite you to contact us to see how we can help manage your revenue cycle and guide your practice to developing an effective compliance program. Contact Barry Shatzman at 800-895-9563, or barry@mbrbilling.com.
