Building A Culture of Compliance

Filled under: Healthcare Compliance on August 2012

Reducing fraud, abuse and waste in the healthcare system is highly important. Having a compliance plan is a must from this point of view, so healthcare providers should be fully committed to such a system.

Healthcare is compliant when it is documented, charged and billed correctly, when it promotes patient rights and meets all quality standards. Building a culture of compliance means promoting a positive attitude towards compliance activities.

Healthcare providers should promote an active culture of compliance instead of a passive one, which can be more effective and protective against fraud and abuse. After all, eliminating them is always a purpose in the entire system.


Below you can find the most important steps to build an active culture of compliance within a medical facility or a hospital.

1. Constantly conduct internal billing and coding audits

Billing and coding have to be performed twice a year, better with outside auditors that can ensure the compliance of Medicare or Medicaid requirements, too. Internal audits can focus only on the areas in which there is need for a higher concentration, for instance when there are claims on the services provided.

2. Train and educate employees

The facility’s management should conduct periodic educational sessions for all employees. New employees are not the only ones that should be trained on compliance, but actually all workers have to attend educational sessions. The entire staff has to receive new information on compliance and how they should report fraud or errors, in case they are found in the system. Frequent education is without a doubt the most important aspect that can lead an active compliance culture. After all, employees are the most important resource of a healthcare facility and they should properly understand all compliance regulations.

3. Hire a compliance officer

A compliance officer can be hired on full-time, but also this job can be offered to a manager of the healthcare facility, depending on its size. A compliance officer can schedule training sessions with employees, but he can also ensure communication. The officer will also be an active participant in the legal discussions of the medical facility.


4. Respond to detected offenses in the most adequate manner

An employee can detect a misconduct or a noncompliance, but also a fraud in the activity of your healthcare facility. When that happens and the employee reports it in time, management will have to respond in the right manner. For starters, management should thank the employee for promptly reporting the situation. Then, an investigation has to start. These investigations do not necessarily have to be reported during audit controls. When employees raise claims internally, they have to be taken under consideration and investigated with no exception.

5. Maintain open communication

Communication is the key to success. Communication between employees and management, between patients and employees, but also between management and partners has to work perfectly. Communication has to be great for employees to feel safe to come open about certain mistakes found or just to speak about something that seems wrong to them.

People can get quite defensive when finding a irregularity and they may actually feel like their jobs are in danger. This is why it is so important for them to feel like that can be open about anything.

Learning more on fraud and abuse and also on how to build a culture of compliance in your healthcare facility is simple when using a practical resource such as the Heath Care and Abuse Compliance Manual.


From this manual you can learn everything there is to know about legislative and regulatory restrictions, but also how fraud and abuse can be avoided. Check out the Health Care and Abuse Compliance Manual on Amazon to find out more.

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