Fraud and abuse has been an issue for the health care industry almost from its inception. While most providers follow the rules and provide quality care at the highest standards, there are some unscrupulous providers who game the system with a less-than-ethical approach to providing care. For this reason, the Office of Inspector General created compliance recommendations for many sectors within the health . Long-term care, most often in the form of nursing homes, has a great need for compliance reform. Writing a compliance plan for long-term care facilities is a simple process if certain guidelines are followed.
Instructions
1. Perform billing and operational audits to determine deficits in the facility. This is the first step in creating a compliance plan that is not cookie cutter. By reviewing timeliness of billing as well as how the staff performs patient care, the agency can determine potential problems and develop action plans to resolve issues.
2. Prioritize deficits based on how they affect the long-term care facility's ability to meet state and federal guidelines, after the results of the audit are revealed. It may also be necessary to include plans to meet city ordinances as well as any accreditation the facility has.
3. Develop an action plan that addresses the findings of the audit. If it is determined that patients are not receiving baths on a regular basis, implement a plan that requires aides to sign off on a daily basis where baths were performed and explanations when they are not performed.
4. Assign a responsible party for ensuring the plan will be reviewed and audited regularly. Document the plan and schedule a date for follow-up and completion.
5. Follow the Office of Inspector General guidelines for compliance for long-term care facilities. The OIG has developed recommendations for compliance for several areas of health care. Long-term care is one of those areas. Following the government's guide for compliance will guarantee any plan that meets the appropriate standards for a compliance plan.
6. Combine the recommendations from the OIG with the action plan from the on-site audit to create a list of policies and procedures for compliance for the long-term care facility. This step ensures that the plan meets global standards of the industry as well as particular problems that exist with the facility.
7. Find an existing compliance plan and use it as a template for formatting the compliance plan. There is no need to reinvent the wheel. Customization has already occurred earlier with the findings from the audit. Using a template ensures that the plan will have the look and feel of a compliance plan. Don't use copyright material word for word. This should only be a tool for organizing ideas.
8. Write a fresh compliance plan using the action plan, OIG recommendations and compliance template that have been created and/or reviewed. Don't attempt to make the first draft perfect. Make sure the main ideas that need to be conveyed are communicated in a succinct way throughout the plan.
9. Allow respected individuals in the long-term care industry to review and edit the plan. Ask questions about how they perceive the intention of the plan and allow them to ask questions about specific goals within the plan. Follow the same process with an attorney.
Tags: compliance plan, long-term care, plan that, action plan, care industry, health care