Certification in Health Care Compliance

Filled under: Healthcare Compliance on June 2010

When it comes to medical coding and billing there are many factors that play a role in how the operations of a business are executed. In many cases, there are certain restrictions that each insurance company will put in place when it comes to billing those companies for whatever procedure may be needed to treat the patient. However, there is no company that is more restrictive than Medicare and Medicaid.

First, it’s not company or private investors’ money that is used to pay the medical bills of millions, it is the money that Medicare receives from taxation and other government instated fees. This means that when the promises of the current generation aren’t fulfilled, the younger generation will need to adjust; and if adjustments continue, there will eventually be no money left.

Fortunately, to eliminate waste and abuse, Medicare has set up what’s known as a compliance act. Included in the 2005 Deficit Reduction Act, the Medicaid Integrity Program (MIP) puts more stringent regulations on the payment options available to providers who accept Medicare/Medicaid patients. However, because of these regulations there is now a need for internal safeguards to avoid fines and, in the worst cases, jail time.

One of the ways to do this is for the facility to either hire a specialist in compliance, or to set up a compliance program themselves. In either case, there is a definite need for people to understand nearly all aspects of the MIP. Because of the depth of the skills and knowledge needed, there have been many schools that have begun specializing in the certification of health care compliance officers and consultants. While it is not necessary to go through a school to receive the proper training, it is a great way to better understand the complexities of the system and create a compliance program that will be effective.

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