Nursing free essay: Medical Compliance Plan
Medical Compliance Plan
The need for an institution to have a practice plan particularly in the health industry goes beyond service delivery efficiency since the overall impact on health and society is invaluably important. In view of the various quality assessment concepts that the institution and its clients derive form a suitable practice plan, the specifics of beneficial impacts can be isolated. Firstly, a practice plan is needed to improve management oversight role for such a sensitive institution. In a well-implemented plan, managerial roles and service delivery can be projected to deliver impeccable results as opposed to an implementation arrangement without a particular plan. Secondly, the improvement and sustenance of quality of service delivered to clients is likely to be guaranteed if a deliberate plan exists for highlighting quality service delivery (Collard, 2012). Alternatively, establishment of the appropriate business and health concepts with regard to productivity is important for sustainable operations as captured in the spirit of a medical practice plan.
Organizational commitment to standards provided by professional bodies across the various departments in the medical institution is facilitated if a working practice plan is implemented. For instance, the compliance demands provided by doctors and other medical practitioners’ bodies could not be implemented without a plan integrating other regulatory demands such as from legal regulations. In addition, other professional bodies involved in management such as accountants, auditors, human resource and security bodies must be incorporated within the overall institutional policy. Updating regulatory demands as changes emerge from various developments in professional practices need an integrated approach, which can only be offered through a plan incorporating all those functionalities.
Among the most important demands for consideration in the plan for the medical practice setting with regard to anti-fraud policies include; internal control standards, focus on medical practice, billing functionalities, standing orders compliance, fraud alert system, marketing functionality, interaction with potential inducements as well as documentation and authentication elements (The Voyager, 2012). To achieve such levels of compliance demands in a functional institution, a compliance implementation department or office must be created for constant surveillance of commitment to its implementation. Alternatively, training functionality of the plan must compliment the implementation processes since resistance and ignorance among the staff levels may hinder satisfactory implementation. Sufficient efforts must be dedicated to ensure that education platforms for the institution supply enough compliance preparedness. Communication parameters for the plan within the institution require a constant appraisal to facilitate less hindrance to perfect interaction among the various levels of employees.
In order for the plan to support the operations of the institution, discipline enforcement mechanisms must always play a role in the overall commitment to compliance. It therefore implies that the institution must balance commitment elements with a reward system to act as an incentive among the various degrees of workers. Correction concepts in cases of deviations in the implementation needs must also constitute the plan requirements in order to ensure constant commitment to the quality needs in every department. Appraisal of the plan requires a constant evaluation and monitoring functionality, which when coupled to the internal control standards can deliver results for the prevention of fraud. The importance of surveillance for purposes of auditing cuts across the most compliance needs of the institution, to ensure a uniform departmental compliance approach. To ensure a balanced opinion in the performance of the internal control standards proposed by the plan, it is advisable that an external opinion forms part of the evaluation plan. Special agents from outside the institution must have a chance to appraise the performance of the institution in terms of compliance with anti-fraud provisions.
In terms of the demands of the compliance plans, institutions find it difficult to ensure constant performance without instances of non-compliance from all parties and officials (Haber, 2007). When internal capacity of the plan is compromised in detection of defaulting practices, several consequences may face the institution in its quest to fight malpractices. Auditing functionalities for instance target detection of errors that may be intentional or unintended during ordinary operation processes. Compromised auditing functionality implies that several errors may go undetected and expose the entire operations into risks arising from the faulty operations. Lack of appropriate responsibility allocation needs implies that the institution will find it difficult to capture incompetent officials in the system thereby leading to continued suspicion and poor quality. Poor communication systems expose the institution into a heresy basis of delivery of official information, causing tension and compromised trust among employees. Overall outcomes of a non-functional system in the detection of fraud expose the institution to fraud and other financial crimes.
Collard, L. (2012). “How to Implement a Medical Billing Compliance Program,” http://www.wikihow.com/Implement-a-Medical-Billing-Compliance-Program
Haber, K. J. (2007). “Your Medical Office Compliance Program: How to Avoid the FBI, OIG, MFCU,” Retrieved from http://www.haberslaw.com/YourMedicalOfficeComplianceProgram-Avoid%20FBI.pdf
The Voyager (2012). “The Four Steps of Developing a Medical Practice Compliance Program,” Retrieved from: http://atlanticfinancial.wordpress.com/2011/01/07/the-four-steps-of-developing-a-medical-practice-compliance-program/
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