Importance of Medical Compliance Plans

Medical compliance plans are programs that healthcare organizations start which are
meant to help it to adhere to legal, ethical, and professional standards that are applicable to
the healthcare organizations. Such programs often have many components. They include
clearly stated procedures, policies, and processes that define appropriate conduct for staff in a
healthcare organization (Bodenger & Steiner, 2017). Since the legal, ethical, and professional
standards that the healthcare organization ought to adhere to keeps on changing, the policies,
procedures, and processes that define appropriate conduct of staff also need to be changed
accordingly.

The other component of medical compliance programs is education of staff. Staff
such as physicians, pharmacists, nurses, and medical billers and coders need to be educated
about the standards that they need to adhere and the consequences of not adhering to the
standards or regulations. For the training to be effective it needs to be done regularly, like
once or twice a year (Bodenger & Steiner, 2017). More importantly, a medical compliance
plan should have a means of enforcing the regulations or standards that are applicable to the
organization.

The benefits of a compliance are significant. By helping healthcare organizations to
comply with ethical, legal, and professional standards that apply to it, medical compliance
plans help healthcare organizations to avoid waste, abuse, and fraud. All these are liability
areas that can lead to loss of money and reputational damage (Bodenger & Steiner, 2017).
Thanks to an effective compliance program, healthcare organizations can either completely
prevent or quickly detect any action by their staff that violates applicable state and federal
laws, professional requirements, business policies, or the organization’s own ethical policies.

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For instance, a robust medical compliance program will prevent staff from submitting false
claims for payment to insurance providers or will notice such claims before they are
submitted to the insurance provider.

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References

Bodenger, G., & Steiner, J. E. (2017). Developing, implementing, and maintaining an
effective compliance program. Journal of Health Care Compliance, 19(1), 19-52.