Other Articles Published by: BC Advantage
BC Advantage (BCA): How did you make your start in this industry?D. K. Everitt (D.K.E): I spent 20 years as a medical administrator and then formed a consulting company. After 10 years I sold the company to a major consulting firm and started The Compliance Division, LLC. I have been involved in establishing and managing federally certified health clinics, evaluating and assessing medical facilities, implementing Corporate Integrity Agreements, developing and implementing compliance programs and OSHA and HIPAA compliance training. In addition I have directed compliance assessments, compliance officer training, compliance education and training, and interacted with federal and state regulatory agencies. I have been privileged to serve as an Affiliate Faculty member and adjunct lecturer for the Trinity University graduate Health Care Administration Department.
BCA: Why did you choose this direction for your career?D.K.E: It was a natural progression. My interest in the federal and state regulations as well as the policies and procedures relating to medical administration proved to be the cornerstone of becoming a compliance officer.
BCA: What are the fundamental building blocks for a successful OSHA compliance training program?D.K.E: Responsibility for OSHA training is but a small part of the duties of a compliance officer. We have found that once a provider understands the need for OSHA training (mandated by federal regulation), a seed has been planted for a successful compliance program. The building blocks for an OSHA training program center on the four plans (Exposure Control Plan, Exposure Incident Protocol, Hazard Communication Plan, Emergency Action Plan). Training should be provided initially and annually thereafter.
BCA: As a speaker what are some of the most asked questions by your students?D.K.E: How long is this class?Is there going to be a test?
BCA: As a speaker what are some of the most asked questions by industry professionals?D.K.E: How long is this class?Is there going to be a test?
Both students and industry professionals are interested in the new rules and HITECH changes for HIPAA. Also, an enormous amount of interest centers around the RACs, ZPICs and other contractors working in conjunction with the federal government to audit medical practices.
BCA: There are many associations out there, why did you choose to align yourself with PMI?D.K.E: PMI and I go back many years. The original founder of PMI, Jim ODell was a good friend. The foundation for PMI was education at a superior level and continues today. PMI has been the training and credentialing source for medical office professionals in the U.S. for more than 25 years. PMI brings together an experienced faculty to educate, train and credential practice managers and anyone involved in the compliance process for the medical office.
BCA: PMI is now offering a new credential: "Certified Medical Compliance Officer (CMCO)"which you helped create. Who should look to obtain this credential and what doors could potentially open for them?D.K.E: Compliance expertise is the future of health care. This expertise is needed in all areas including administration and clinical. The compliance officer is essential to protecting the long-term viability of the practice. Having a working knowledge of the responsibilities and duties of a compliance officer strengthens a health care workers opportunities for advancement and provides an invaluable service to their provider.
BCA: In your opinion, what separates the PMI compliance program apart from other programs currently available?D.K.E: The PMI CMCO program was created specifically for small to medium sized outpatient care facilities, third party billing companies, management companies and more. Other programs that I have been associated with deal with hospital based issues and requirements. PMI is careful to ensure that their program meets the highest standard so that the participants understand how to develop, implement, and manage a complete Compliance Program.
BCA: What are the major issues facing the industry in regards to HIPAA?D.K.E: With the implementation of the HITECH rules, the fines for HIPAA violations have increased and Health care organizations could be held legally responsible for HIPAA violations if it is found that they failed to implement and enforce appropriate policies and procedures to prevent violations from happening.
Members of a covered entitys workforce must receive training on their organizations policies, procedures and practices regarding the privacy, confidentiality and security of health information. If a policy to protect PHI is in place, but it is found that employees dont know it exists or dont understand it, an institution can be held liable for violations. However, if a health care organization has developed appropriate policies and procedures and can prove that it has adequately educated its workforce, then the specific person or people guilty of a willful violation could be held personally responsible and face fines and prison.In addition, an individual who is harmed by an act that constitutes a HIPAA violation may receive a percentage of any civil monetary penalty or monetary settlement collected with respect to that offense.
BCA: What advice would you give to our readers to assist them in staying compliant?D.K.E: Take the CMCO course. The medical industry is changing so rapidly, it is impossible to keep up without outside resources like PMI providing training, seminars and webinars on a regular basis. The Compliance Division, LLC also offers manuals and information on their website (www.thecompliancedivision.com), including a Compliance Checklist.
BCA: When you first go to a clients office and take a look around, what are the first issues you tend to see and how do you go about fixing these issues?D.K.E: The staff in a medical practice determines every patients initial impression of that office. That is my first impression as well. I then take into account the appearance of the office (clutter, organization, cleanliness). Then I move on into specific areas I am reviewing. The findings are provided in a written deficiency report along with recommendations on how to address the issues.
BCA: Can you explain the Corporate Integrity Agreement (CIA) to our readers and why it is important?D.K.E: The Office of Inspector General negotiates Corporate Integrity Agreements (CIA) with health care providers and other entities as part of the settlement of Federal health care program investigations arising under a variety of civil false claims statutes. Providers or entities agree to the obligations and, in exchange, the OIG agrees not to seek their exclusion from participation in Medicare, Medicaid or other Federal health care programs. A comprehensive CIA typically lasts 5 years. It is important because training, policies and procedures, designating a compliance officer, or implementing of a communications hot line, are built into the CIAs and are designed to ensure that fraudulent behavior does not occur again. In other words, it gives the provider a second chance by allowing them to continue to participate in federal healthcare programs.
BCA: What main points would you suggest be implemented to ensure every office is ready for an OSHA inspection?D.K.E: As we stated earlier, it is imperative that each employee be made aware of the four basic plans for OSHA. They should also be offered the Hepatitis vaccination within 10 days of employment. Training records should be up to date and must be maintained for three years. Employee medical records must be up to date and be maintained for the length of employment plus 30 years. Be sure multi-use products are dated and labor law posters are posted and up to date. Make sure exits are properly marked and evacuation maps are posted. These are just a few of the areas that might be reviewed during an inspection.
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