At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 16, Scott Becker, JD, CPA, partner at McGuireWoods and Holly Carnell, JD, McGuireWoods in Chicago spoke on the seven core elements of cultures of compliance in ambulatory surgery centers.
1. Conduct internal monitoring and auditing. This is the most critical element of all, as it has the most preventive capabilities. Mr. Becker recommended ASCs conduct internal audits on a periodic basis. "The more time that goes by, the more chance there is for a surprise when you do perform an audit," he said.
2. Implement compliance and practice standards. ASC leaders should strive to create active cultures of compliance rather than passive compliance plans "that sit on a shelf," according to Ms. Carnell. A culture of compliance, or lack thereof, can determine whether an instance of improper billing is an act of fraud or an error.
ASC employees will note whether they are working in an actively compliant environment. "When an FBI agent shows up, the people who will be witnesses against you are your staff, partners and employees. They've either heard you're running an ethical operation, or they've heard you're taking every last dollar off the table," said Mr. Becker.
3. Designate a compliance officer or contact. This may be an individual from administration or a lead physician, and he/she should be extensively involved in all matters of an ASC's discussion and initiatives around compliance. It's a bad sign when the compliance officer is nowhere to be found, according to Mr. Becker. "You need to be sure you're being open and honest with your compliance officer and always include them in compliance discussions," he said.
4. Conduct appropriate training and education. "Regularly inform people and educate them on critical areas," said Mr. Becker. Along with education, ASC administrators should instill the values of open communication and transparency in compliance training. "Foster and encourage people to bring issues forward rather than hide them," he added.
5. Respond appropriately to detected offenses, and develop corrective action plans. "When someone comes to you with a compliance problem, there is only one answer: 'Thank you so much, we're going to look into it,'" said Mr. Becker. "Take it seriously and follow up. That person needs to hear you're concerned, then go figure out what to do to so it is solved appropriately."
6. Develop open lines of communication. When conducting an investigation, it is paramount that hospital executives and employees are able to discuss matters in an honest environment with trust. "Some people are very defensive. They feel their job is on the line. Certain executives feel it's their job to defend the organization and make sure no bad behavior is uncovered, even though we're on their side," said Ms. Carnell. "Being able to foster an environment of trust in any investigation is key to getting all the facts and working to a resolution."
7. Enforcing disciplinary standards through well-publicized guidelines. ASCs need to demonstrate consistency and objectivity when enforcing rules of compliance. Individual employees, despite their high productivity or prominent reputations, should not receive more leeway than others and leadership should address their problems with compliance immediately. "One of the most challenging situations for [ASCs] is when the best revenue-producers are the worst in terms of compliance. It's terrible stress on leadership," said Mr. Becker.
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1. Conduct internal monitoring and auditing. This is the most critical element of all, as it has the most preventive capabilities. Mr. Becker recommended ASCs conduct internal audits on a periodic basis. "The more time that goes by, the more chance there is for a surprise when you do perform an audit," he said.
2. Implement compliance and practice standards. ASC leaders should strive to create active cultures of compliance rather than passive compliance plans "that sit on a shelf," according to Ms. Carnell. A culture of compliance, or lack thereof, can determine whether an instance of improper billing is an act of fraud or an error.
ASC employees will note whether they are working in an actively compliant environment. "When an FBI agent shows up, the people who will be witnesses against you are your staff, partners and employees. They've either heard you're running an ethical operation, or they've heard you're taking every last dollar off the table," said Mr. Becker.
3. Designate a compliance officer or contact. This may be an individual from administration or a lead physician, and he/she should be extensively involved in all matters of an ASC's discussion and initiatives around compliance. It's a bad sign when the compliance officer is nowhere to be found, according to Mr. Becker. "You need to be sure you're being open and honest with your compliance officer and always include them in compliance discussions," he said.
4. Conduct appropriate training and education. "Regularly inform people and educate them on critical areas," said Mr. Becker. Along with education, ASC administrators should instill the values of open communication and transparency in compliance training. "Foster and encourage people to bring issues forward rather than hide them," he added.
5. Respond appropriately to detected offenses, and develop corrective action plans. "When someone comes to you with a compliance problem, there is only one answer: 'Thank you so much, we're going to look into it,'" said Mr. Becker. "Take it seriously and follow up. That person needs to hear you're concerned, then go figure out what to do to so it is solved appropriately."
6. Develop open lines of communication. When conducting an investigation, it is paramount that hospital executives and employees are able to discuss matters in an honest environment with trust. "Some people are very defensive. They feel their job is on the line. Certain executives feel it's their job to defend the organization and make sure no bad behavior is uncovered, even though we're on their side," said Ms. Carnell. "Being able to foster an environment of trust in any investigation is key to getting all the facts and working to a resolution."
7. Enforcing disciplinary standards through well-publicized guidelines. ASCs need to demonstrate consistency and objectivity when enforcing rules of compliance. Individual employees, despite their high productivity or prominent reputations, should not receive more leeway than others and leadership should address their problems with compliance immediately. "One of the most challenging situations for [ASCs] is when the best revenue-producers are the worst in terms of compliance. It's terrible stress on leadership," said Mr. Becker.
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