Jeannine LeCompte, Publishing and Research Coordinator
All long-term care facilities (LTCs) which use Medicare or Medicaid funding are required to submit an annual report to their compliance and ethics committee, specifying in detail how the facility or facilities have been legally compliant throughout the preceding year.
The fiduciary compliance responsibility means that management must ensure that there is sufficient oversight of the financial aspects of the day-to-day operations of the company. This will in turn ensure that all funds originating from Medicare and Medicaid are used for the purpose intended, and in full compliance with the law.
In this regard, the LTC’s annual report must state if the organization is compliant with the following:
- A compliance committee meets and maintain records
- An institutional budget plan exists
- There are appropriate coding policies and procedures
- There are appropriate policies and procedures in place in case of overpayment
- There is a comprehensive conflict-of-interest policy
- There is a written policy on gifts and gratuities
- There are clearly defined policies and procedures on waivers of co-payments and deductibles
- Compliance audits are regularly carried out
- Compliance risk assessments are developed which incorporate all the relevant aspects of the demands made by federal and state regulatory agencies
- The compliance committee, and the compliance officer in particular, maintains complete knowledge of current regulatory changes and interpretation of laws
- There is ongoing compliance education for all staff
- The compliance program’s effectiveness is continually evaluated and reviewed for any lapses
- All budgetary estimations are as accurate as possible
The healthcare sector operates in a highly regulated environment, and an effective compliance program will greatly reduce the risks inherent in using funds provided by the government.
