CB - Claims and Billing Policies and Procedures Sample

Claims and Billing Compliance

CB.1

Compliance Program

Benefits of Compliance Plan

The company believes an effective compliance program provides a mechanism that brings the public and private sectors together to reach mutual goals of reducing fraud and abuse, improving operational quality, improving the quality of health care services and reducing the cost of health care. Attaining these goals provides positive results to the company the Government and individual citizens alike. In addition to fulfilling its legal duty to ensure that it is not submitting false or inaccurate claims to Government and private payers, the company will gain numerous additional benefits by voluntarily implementing an effective compliance program.

Goals and Benefits of Compliance Program

•  The formulation of effective internal controls to assure compliance with Federal and State statutes, rules, and regulations, and Federal, State and private payer health care program requirements, and internal guidelines;

• A concrete demonstration to employees and the community at large of the company's strong commitment to honest and responsible corporate conduct;

•   The ability to obtain an accurate assessment of employee and contractor behavior relating to fraud and abuse;

•   An increased likelihood of identification and prevention of criminal and unethical conduct;

• The ability to more quickly and accurately react to employees' operational compliance concerns and the capability to effectively target resources to address those concerns;

•   Improvement of the quality, efficiency, and consistency of providing services;

• Increased efficiency on the part of employees;...