Discussion Designing and Implementing an Effective Compliance Plan

HSA 546 Week 9 Discussion Designing and Implementing an Effective Compliance Plan

The Office of Inspector General (OIG) has established a set of guidelines (e.g., auditing, monitoring, internal controls, sampling, due diligence, and standards of organizational and employee behavior, etc. Page 508 of the textbook) that physician practices should follow when creating a compliance plan. State an opinion as to which OIG guideline would be the single most significant aspect of a compliance plan for a small practice. Provide a rationale for your response.

The advancement of these types of compliance plan guidance’s is established on our trust that a health care professional can use internal restrain to more proficiently observe adherence to appropriate decrees, regulations and plan necessities. Foundations for an Effective Compliance Program: This compliance guidance for physician practices includes features that the OIG has persistent to be foundation to an efficient compliance plan:

The Office of Inspector General (OIG) of the Department of Health and Human Services (DHHS) advances in its efforts to endorse willingly implemented compliance plans for the health care organization. The terminology (i.e., Federal health care programs) contains any program that offers medical benefits, even if directly, by means of insurance, that is paid directly, in full or in partial, by the US Government (i.e., through plans such as Medicare, Federal Employees Health Benefits Act, Federal Employees’ Compensation Act, the Longshore and Harbor Worker’s Compensation Act) or any State health plan (e.g., Medicaid, or a program receiving funds from block grants for social services program requirements. Guidelines, an industry should have developed.

  1. Carrying out written policies, procedures and standards of conduct;
  2. designating a compliance officer and compliance committee;
  3. conducting successful training and education;
  4. creating successful lines of communication;
  5. implementing standards through well publicized disciplinary code of conduct;
  6. conducting internal monitoring and auditing; and
  7. responding promptly to detected offenses and developing corrective action.

Wolper, L. F. (2013). Physician Practice Management (2nd ed.). Burlington, MA: Jones & Bartlett Learning


According the text, the fundamental purpose of a compliance plan is to create an organizational culture that promotes the prevention, identification, and resolution of issues associated with risk. Suggest two (2) main aspects of a management strategy necessary to create this type of culture. Support your recommendations with at least one (1) real-world example.

Several such regulations, of course, are practical and do decrease several risks that might severely hurt an organization. The initial phase in establishing an efficient risk-management network is to comprehend the qualitative distinctions between the types of risks that industries encounter. This risk group is best managed due to active hindrance: monitoring operational procedures and guiding individual behaviors and choices toward need standards. After significant data currently exists on the rules-based compliance method, we introduce interested individuals to the sidebar (Identifying and Managing Preventable Risks) in lieu of a complete best practice. A powerful corporate culture illuminates what is not permitted. Category II: Strategy risks: An organization voluntarily take various risk to generate first-rate returns from its plan: A bank excepts credit risk, for instances, when it loans money; some health care industries take on risks because of their ongoing research and development actions.

Wolper, L. F. (2013). Physician Practice Management (2nd ed.). Burlington, MA: Jones & Bartlett Learning


In your own words, please explain what we mean by an organizational compliance plan and what effect it can have on the overall management of a practice?

An industry should have value of control and internal conducts rationally efficient of decreasing the possibility of illegal and additional inappropriate conduct. The code should include a complete description of the plan and tackle in a real-world manner the compliance liabilities that are pertinent to the industry. It must display openly those who are liable for managing the plan, the position of the governing control, and offer overall advice on the organization conduct likely of all workers. Depending on the organization, there are many conduct manuals, for example as those indicated above, that try to demonstrate the types of regions that must be discussed. Efficient open communication with staffs concerning compliance regarding, misgivings, or grievances are vital. Employees should be calm talking with a compliance officer or manager concerning compliance issues that might come about.

Wolper, L. F. (2013). Physician Practice Management (2nd ed.). Burlington, MA: Jones & Bartlett Learning

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