Small group and solo physician practices soon will have the same type of guidelines for compliance with federal law as their larger counterparts. But, unlike hospitals and other large providers, they won't be required to adopt the government's suggestions.
The Office of Inspector General issued its Compliance Program Guidance for Individual and Small Group Physician Practices on June 7. The comment period ends July 27. The final guidelines are expected to be published later this year.
Although analysts say the guidelines are significantly more flexible than those for large group practices, the guidelines still will be "a large burden," says Jeffrey Scribner, a director with ZA Consulting's hospital physician compliance group in Philadelphia. "Physician practices in general don't have the wherewithal to comply with these regulations or to comply with this . . . Larger practices already have . . . compliance (programs). The smaller ones--the two, the three, the solo practitioner--I don't know how (they're) going to do it."
Officials say the guidelines are completely voluntary. The idea was to give physicians a handbook to avoid errors and compliance problems, says Alwyn Cassil, inspector general spokesperson. But the government strongly urges practices to develop compliance programs which can be seen as mitigating factors should fraud or abuse issues arise, Cassil says.
Based on seven elements, the guidelines are designed to reduce fraud and abuse in Medicare billing. They are similar to those issued by the inspector general for clinical laboratories, hospitals, home health agencies, third-party medical billing companies, durable medical equipment companies and others.
Under the law, physicians aren't subject to penalties for innocent errors or negligence. The False Claims Act covers only offenses that are committed with actual knowledge of the falsity of the claim, reckless disregard or deliberate ignorance of the truth or falsity of a claim.
Scribner says physician practices in rural areas will have a difficult time with the regulations. "There's going to be a big market for outsourcing compliance programs for physicians."
Officials at the Medical Group Management Association were concerned about what the guidelines would contain, says Aaron Krepp, MGMA government affairs representative.
"We have some mixed feelings," Krepp says. Physician practices, particularly small ones, have limited human and monetary resources, he says.
One suggestion MGMA officials made and the government accepted was that small practices be allowed to share compliance officers, Krepp says.
MGMA officials were pleased that small practices don't need to establish a toll-free number so employees can report compliance violations as long as the practice maintains an open-door policy with no retribution to the person making the report, Krepp says.
Scribner says the compliance officer, shared or not, will need to have clear authority, clear lines of reporting and a clear understanding of how to discipline people who aren't in compliance, he says. Getting physicians to accept that authority may be a problem, Scribner says.
MGMA officials also want clarification on a couple of points, For example, Krepp says, throughout the proposal, the word "essential" is used at the same time the government says those guidelines aren't mandatory.
The inspector general should be more flexible in terms of required audits, Krepp says. "I think sometimes they forget a lot of small practices (have) only two physicians," he says.
Guiding handThe Office of Inspector General's draft physician guidance program is based on seven elements:
- Implementation of written policies and standards of conduct
- Designation of a compliance officer or contact
- Development of training and education programs
- Creation of accessible lines of communcation to keep practice employees updated about compliance activities
- Performance of internal audits to monitor compliance
- Enforcement of standards through well-publicized disciplinary directives
- Prompt corrective action for offenses