Healthcare providers should keep their practices safe from any fraud, abuse, and waste related to revenue collection. Therefore, the US government has introduced compliance policies that can prevent your medical laboratories from any legal suites.
Since all healthcare practices including the medical labs are prone to billing errors. As a result, the federal officials are more concerned to reduce such areas of the problem from the federal healthcare system. The Officer of Inspector General (OIG) believes that honest members of the healthcare community should follow practical guidelines to police themselves.
In this regard, the OIG has published Compliance Program Guidance documents for the overall healthcare industry.
Voluntary Compliance Program
A laboratory based on the Office of the Inspector Generals (OIG’s) introduced a set of guidelines known as a “Voluntary Compliance Program”.
The voluntary Compliance Program was published;
- To reduce or eliminate improper medical bills to Medicare.
- To hold the healthcare community back from criminal activities.
Medical labs should effectively develop and implement compliance programs for their business. In return, it would enable them to receive special consideration when any problem arises involving government investigation.
Laws and Regulations that Govern Laboratories
1. Social Security Act:
Medicare and Medicaid laws are the essential participants of this act. Even, Medicare defines its rules and regulations under this act.
2. Anti-kickback laws:
It encounters and penalizes those criminal individuals or entities who knowingly and intentionally offer, pay, solicit or receive money.
If Medicare or Medicaid programs are paying for healthcare services or medical tests. Then this law penalizes those individuals or entities who favor the referral of such tests and services.
3. False Claims Act:
According to this act, the government penalizes providers who deliberately file a claim to a government payer agency.
4. Self Referral (Stark) laws and Regulations:
If you have such financial relationships that can directly favor the referral of any patient or entity. Then make sure that the patient or related entities meet the certain requirements of referral.
Otherwise, Self Referral laws and regulations impose the following sanctions in case of violation of rules.
The US government doesn’t allow Medicare to pay for DHS furnished patients. Therefore, it prohibits the referral of such DHS.
Even if providers file a claim for these services_ it ends up in the form of denial. As a result, you receive no reimbursement for such services.
Refund of Payment:
Any entity that has somehow collected payment for a DHS furnished pursuant must timely refund all the collected amounts.
Those healthcare entities who violate the Stark law would get eliminated from participating in the Medicare and Medicaid programs. Remember! this sanction is not applicable to federal healthcare programs.
5. Health Insurance Portability and Accountability Act (HIPPA):
The 1996 HIPAA act was introduced to set the standards for patient data protection. Also, it requires healthcare providers (including lab operators) to use a secure network/channel for data transmission.
- HIPAA certification is essential to ensure reliable medical billing and coding process. Even if providers use the electronic medium for information transactions.
- Still, they should strive to address the technical and non-technical safeguards to honor the privacy of patient’s information.
- Providers even shouldn’t allow anybody to read the patient’s information without any necessity.
- They must also not allow their co-workers or anyone outside of UCLA healthcare locations to access the data. Only, they can use that data if they have work-related to it.
- It is inappropriate to share patients’ information with anyone who comes to the clinic, hospital or any medical labs.
- You should also not place your computer systems or manual files of patient’s records in the public eye. Most importantly, do not keep these confidential records in such locations that are specifically involved in that patient’s care.
- Employees should use shredding bins to discard any confidential information about a patient’s healthcare.
- Let your supervisors deal with the information of stray patients.
If healthcare providers (including medical lab employees) fail to comply with HIPAA standards. Then the government penalizes your practice in the following ways;
- File Criminal charges.
- Apply monetary fines to individuals that could be up to $250,000.
- Declare 10 years of imprisonment.
Running a healthcare business is not solely dependent on the quality of medical services.
Like every other industrial domain, one should also take care of the financial details. For this purpose, laboratories should strive to streamline their Lab RCM.
They should ensure that they are collecting the right amount in return for their services by following the federal compliance guidelines.
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