Policies and Procedures

Question 1

When must compliance policies and procedures and standards of conduct be distributed to employees?

Answer 1

Within 90 days of hire, when there are updates, and annually thereafter

Question 2

What is the purpose of the Code of Conduct?

Answer 2

State the overarching principles and values by which the company operates and defines the underlying framework for compliance policies and procedures.
Describes company’s expectations that employees conduct themselves in an ethical manner; that issues of noncompliance be reported; and that reported issues will be addressed.

Question 3

When should policies and procedures be updated?

Answer 3

when there are changes in applicable laws, regulations and federal healthcare program requirements

Question 4

What are the two main categories of policies and procedures?

Answer 4

1. Risk specific policies and procedures that address organization’s obligations under a specific set of laws and provide meaningful guidance to employees about how to do their jobs in compliance with these legal requirements
2. Policies and procedures designed to implement the other elements of an effective compliance plan and guide how to respond to compliance failures

Question 5

The US Sentencing Guidelines emphasizes what key factor when reviewing Codes of Conduct?

Answer 5

Tone at the top. Look for message from CEO.

Question 6

What sources should be reviewed in identifying topics to be addressed in compliance policies?

Answer 6

1. existing standards of conduct and P&Ps
2. results of organization’s risk assessment and audits
3. OIG compliance guidance and other government sources
4. industry practice
5. the organization’s compliance experience

Question 7

Who should be involved in development of policies and procedures?

Answer 7

Operational managers and compliance committee

Question 8

What are some specific areas of OIG concern that should be addressed in provider policies and procedures?

Answer 8

Billing for services not rendered; upcoding; unbundling; anti-kickback; stark; providing medically unnecessary services; duplicate billing; etc.

Question 9

When should legal counsel be consulted about policy development?

Answer 9

For policies and procedures relating to compliance investigations and enforcement

Question 10

Policies and procedures relating to compliance investigations and enforcement should include…

Answer 10

• procedures to ensure that there is a final disposition of the matter, either internally or with the authorities if warranted
• clearly provide for reports of all investigations to reach senior management and the governing body for their consideration of material compliance breaches, their impact on the organization and the adequacy of the remedied measure
• provisions regarding confidentiality and protection of employee rights
• nonretaliation in connection with reports and compliance failures
• notice that failure to report or cooperate may result in discipline