Maintaining compliance is more critical than ever in the ever-evolving landscape of long-term care. As a third-generation nursing home provider, I have seen the industry grow, and the rules become more complex.
A proactive compliance program, implemented with specific compliance measures, is essential to navigating these challenges effectively.
Here’s a new look at the seven important parts of a good compliance program. This is especially relevant now with the focus on mandatory corporate compliance.
1. Establishing a Compliance Program in Nursing Facilities
Establishing a compliance program in nursing facilities is crucial to ensuring compliance with applicable statutes, regulations, and program requirements.
The Office of Inspector General (OIG) has created a set of voluntary compliance program guidance documents (CPGs) to promote internal controls in the healthcare industry, including nursing facilities and other healthcare providers.
A compliance program in nursing facilities should support quality care that follows Affordable Care Act (ACA) rules. It should also help prevent and find criminal, civil, and administrative violations.
To establish an effective compliance program, nursing facilities should consider the following key elements:
- Written policies and procedures
- Designated compliance officer
- Effective lines of communication
- Compliance training
- Internal reporting system
- Monitoring and auditing
- Enforcement and disciplinary action
A compliance program should meet the organization’s specific needs. This includes risk assessment and mitigation. It should also provide compliance training and education. Regular compliance audits and risk assessments are important, too. The program should include evaluation and improvement. Finally, it needs strong governance and leadership.
2. Compliance Program Guidance for Skilled Nursing Facilities
The Office of Inspector General (OIG) has created detailed guidance for skilled nursing facilities (SNFs). This guidance helps them set up and maintain strong compliance programs, follow laws, rules, and program requirements, and prevent fraud, waste, and abuse.
The OIG’s CPG for SNFs highlights the need for a strong compliance program. This program should have several key elements.
These elements create a strong framework for compliance. They include written policies and procedures, a compliance officer, and clear communication. Compliance training is also important. An internal reporting system helps with monitoring and auditing. Finally, there should be enforcement and disciplinary actions.
A key aspect of the CPG is the emphasis on tailoring the compliance program to the specific needs of the SNF. The program should be regularly reviewed and updated to ensure its ongoing effectiveness. The guidance highlights how important compliance programs are. They help improve the quality of care under the Affordable Care Act (ACA) rules.
SNFs must follow the OIG’s CPG and comply with the ACA. The ACA requires them to have a program that prevents and detects criminal, civil, and administrative violations and promotes quality care that is consistent with its regulations.
SNFs can streamline their compliance efforts by using compliance software such as Compliance Manager. This software offers various features, including a built-in risk assessment, online employee training, and policy management.
These tools can help SNFs create and maintain a strong compliance program, which ensures they meet the OIG’s CPG and the ACA requirements.
1. Corporate Compliance Officer/Designee(s)
Your compliance program’s success starts with the right leadership, which is crucial for all healthcare entities. The compliance officer should be well-respected and have the full support of the entire organization.
The Office of Inspector General (OIG) plans to develop compliance program guidance documents for Medicare Advantage and nursing facilities.
This role sets the compliance tone. It requires being visible and holding everyone accountable to the facility’s code of conduct.
Compliance Program Policies and Procedures
Develop comprehensive policies and procedures that reflect current regulations and best practices. These should be living documents, regularly reviewed and updated to ensure ongoing relevance and effectiveness.
They should incorporate compliance activities to address risk areas and adapt to the unique needs of different organizations. They must also reinforce the importance of documentation.
4. Understanding Compliance Risks in Skilled Nursing Facilities
Skilled nursing facilities face various compliance risks, including fraud, waste, and abuse. The OIG has identified seven elements a compliance program should have to prevent and detect these risks. Understanding these risks is crucial to developing and maintaining an effective compliance and ethics program.
Some of the common compliance risks in skilled nursing facilities include:
- Billing and coding errors
- Lack of documentation
- Inadequate staffing
- Poor infection control practices
- Failure to report incidents
To reduce these risks, skilled nursing facilities should have a compliance program. This program should include regular training and education, compliance audits, and risk assessments. Finally, a compliance hotline should be available.
They should create a compliance committee to oversee the program and effectively prevent and detect compliance risks.
Compliance software, such as Compliance Manager, can help skilled nursing facilities streamline compliance efforts and reduce non-compliance risk.
The software has a built-in risk assessment, online employee training, and policy management. These features make it easier to manage compliance efforts and help ensure that employees understand their compliance responsibilities.
In addition, skilled nursing facilities should ensure that they have a designated compliance officer responsible for overseeing the compliance program and ensuring its effectiveness. They should also establish disciplinary guidelines for non-compliance and ensure that employees understand the consequences of non-compliance.
Skilled nursing facilities can lower compliance risks by understanding them and creating a strong compliance program. This helps them avoid non-compliance and ensures they provide high-quality care to their residents.
3. Effective Lines of Communication
Establish open (and optional anonymous) channels for staff at all levels to report compliance concerns. Transparency is crucial; ensure that all employees feel comfortable voicing issues without fear of retribution. Your organization cannot address concerns without the observations and insights from your staff.
4. Training and Education
Continuous education is vital. The upcoming guidance from the Office of Inspector General (OIG) will focus on compliance risks for clinical laboratories. It will highlight the need for specific internal controls to reduce problems with fraud and abuse.
Implement robust training programs that cover all compliance aspects tailored to different roles within the organization. Regular updates and refresher courses help maintain high awareness and competence.
5. Enforcement and Discipline
Enforce policies consistently and fairly. Clear disciplinary guidelines for non-compliance ensure everyone understands the consequences of violating procedures, promoting a culture of accountability.
6. Monitoring and Internal Audit Systems
Develop strong internal audit systems to monitor compliance regularly. These systems should be repeatable and not reliant on specific individuals but on well-documented processes. Regular audits help identify and address issues proactively.
7. Response to Problems and Corrective Actions
Have a plan in place for addressing compliance issues when they arise. Swift, effective corrective actions are necessary to resolve problems and prevent recurrence. This includes thorough documentation and follow-up to ensure long-term resolution.
Conclusion
Implementing a robust compliance program is not just about meeting regulatory requirements; it’s about fostering a culture of integrity and accountability. We provide tools and insights to help you build and maintain an effective compliance program. Stay tuned for more insights and best practices to ensure your organization is always ahead.
