The following is an excerpt from the Human & Health Services – Guidelines for 3rd Part Medical Billing Companies
- Program Guidance for Third Party Medical Billing Companies
- 1. Introduction
- A. Benefits of a Compliance Program
- B. Application of Compliance Program Guidance
- II. Compliance Program Elements
- A. Written Policies and Procedures – Part I | Part II
- B. Designation of a Compliance Officer and a Compliance Committee
- C. Conducting Effective Training and Education
- D. Developing Effective Lines of Communication
- E. Enforcing Standards Through Well-Publicized Disciplinary Guidelines
- F. Auditing and Monitoring
- G. Responding to Detected Offenses and Developing Corrective Action Initiatives
- III. Conclusion
Through this document, the OIG has attempted to provide a foundation to the process necessary to develop an effective and cost-efficient third-party medical billing compliance program. As previously stated, however, each program must be tailored to fit the needs and resources of an individual billing company, depending upon its particular corporate structure, mission and employee composition. The statutes, regulations and guidelines of the Federal and State health insurance programs, as well as the policies and procedures of the private health plans, should be integrated into every billing company’s compliance program.
The OIG recognizes that the health care industry in this country, which reaches millions of beneficiaries and expends about a trillion dollars annually, is constantly evolving. In particular, the billing process has changed dramatically in recent years. As a result, the time is right for billing companies to implement strong, voluntary compliance programs. As stated throughout this guidance, compliance is a dynamic process that helps to ensure billing companies are better able to fulfill their commitment to ethical behavior and to meet the changes and challenges being imposed upon them by Congress and private insurers. Ultimately, it is OIG’s hope that voluntarily created compliance programs will enable billing companies to meet their goals and substantially reduce fraud, waste and abuse, as well as the cost of health care to Federal, State and private health insurers.
Dated: December 14, 1998.
June Gibbs Brown,
[FR Doc. 98–33565 Filed 12–17–98; 8:45 am]
BILLING CODE 4150–04–P