Credentialing alone doesn’t guarantee compliance expertise

To be OIG and HIPAA compliant it is more than just purchasing a manual or having a consultant come to the office to conduct a compliance or chart audit.  In this article published in ChiroEconomics, we discuss the importance of selecting a certified and knowledgeable compliance consultant. The consultant should assist you in making your practice compliant by determining areas of concern then provide you ways to properly correct those areas. 

Originally published on December 14, 2017 in the Chiropractic Economics Magazine here: https://www.chiroeco.com/credentialing-compliance-expertise/

When one of the authors of this article had the opportunity to attend a seminar on street gangs sponsored by a university in Illinois, the instructor for the class was touted as being an expert on various gangs across the nation.

While attending the morning session, however, he was disappointed and, rather than returning for the afternoon portion, he returned to the training academy to get some work done.

On returning to the police academy, he was questioned by his supervisors why he had left the gang seminar. He explained that the instructor didn’t have a clue about street gangs so he decided to make better use of his time. He already had a working knowledge of the Chicago area street gangs and mentioned that he had never seen palm trees in downtown Chicago.

The supervisors asked what palm trees had anything to do with street gangs. He advised them that during the class, this so-called “gang expert” displayed a picture of gang members with palm trees in the background, and said the photo was taken in downtown Chicago.

His opinion was affirmed several days later when his supervisors were notified by the university that all the attendee registration fees were being refunded as the “gang expert” was a fraud, not an expert.

Experience matters

So, you may be wondering what a phony street gang expert has to do with compliance. Our advice is to beware of false prophets and those claiming to be compliance experts. Just like the person posing as an expert on gangs, there are many people claiming to be compliance experts who have little or no knowledge and expertise in the field.

You can certainly find people who are honestly knowledgeable in compliance matters. But you can also come across those with questionable credentials who are leading people astray along with bilking them out of their money.

For example: At a recent chiropractic conference, a certain vendor was touting himself as being a compliance expert, selling Medicare Office of Inspector General (OIG) and HIPAA compliance manuals. Yet the person who had written the manuals had credentials we had never heard of or seen before.

After leaving the conference, we tried to determine what these claimed certifications were, but were unable to locate anything about them in the compliance realm. It turned out the credentialing was in other subject areas, not compliance.

As we delved deeper into this vendor’s training materials, it appeared there was little substance to the manuals he was selling. It would have been difficult if not impossible for someone to develop an effective compliance program based on the material.

Due diligence

Even if a person does have proper compliance credentials after their name, remain vigilant. Credentialing does not always make someone knowledgeable or a compliance expert. Look into the real-life experi- ence they have in auditing patient files as well as developing effective compliance programs for clients. Request references—don’t just take their word.

Selecting a compliance consultant to assist you in making your practice Medicare OIG and HIPAA compliant is no trivial matter. It involves more than just purchasing a manual or having a consultant come to the office to conduct a compliance or chart audit. There are things to consider such as expenses, time, effort, emotion, and self-reflection that go into building an effective compliance program.

Be certain the consultant is actually knowledgeable in compliance regulations and requirements. They should provide you with correct and up-to-date information for building compliance programs and guide you toward correcting any deficiencies. In the event serious problems are found, the consultant may enlist an attorney knowledgeable in the area of compliance issues.

Some doctors who have hired compliance “experts” later felt like they did not get their money’s worth.

Others have purchased so-called “do-it-yourself” compliance programs only to find they were designed so that the owner has to buy more add-on pieces. Frustration abounds with these types of products.

Erroneous information

In another case, the owner of a practice management business with several chiropractors stated that her clients did not need assistance with compliance because she was well- versed in the regulations. She insisted there were no Medicare guidelines regarding patient care or frequency of care, and the federal sentencing guide- lines in addition to the seven elements of a compliance program were irrelevant to chiropractors.

The wife of another chiropractor said her husband had bought a practice along with the records from a doctor several years prior. She thought her husband was 100 percent compliant, even though she admitted they did not have OIG and HIPAA compliance programs and manuals for the practice. This type of misinformation could cost the doctors and their practices dearly if they were audited or investigated.

The elements of a compliance program

One of the seven elements of a Medicare OIG compliance program is to institute auditing and internal monitoring. The OIG has stated the auditing portion must be conducted by an independent certified entity with expertise in compliance regulations.

You’re looking for a neutral and knowledgeable viewpoint to create a baseline for your compliance program. A “do-it-yourself” audit kit won’t fulfill the requirement of an independent entity despite some who say it is OK to self-audit. Contrary to common belief, an effective compliance program is more than having manuals on a shelf. In addition, the OIG requires that 10 charts be reviewed to establish a valid baseline audit.

When you make the decision to develop a compliance program, seek the assistance of consulting specialists who will discuss the following items with you:

  • Their lineage of certification and compliance philosophy.
  • The specific compliance training certifications they have.
  • The continuing education and additional training they have taken.
  • Their experience in conducting audits and developing compliance programs.

Just as you follow a chiropractic philosophy, the same goes for compliance specialists. Proper compliance programs and patient chart documentation give you the ability to rebut and defend yourself during an audit.

You will be able to sleep easier. And beware of false prophets and compliance “experts.”

About Diane M. Barton, DC, MCS-P, CIC & James Minx MCSP, CIC

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