Compliance Programs Soon Required For All Medical Providers

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Formal compliance plans will soon be required to participate with Medicare.

Peak Performance Physicians, LLC announced today that compliance programs will soon be required for all medical providers. John W. McDaniel, President and CEO, stated that "compliance programs not only ensure adherence to federal guidelines, but are also an excellent way of conducting business, particularly with respect to coding and billing."

Prior to the recent passage of the health reform legislation, many groups, both governmental and private, recommended that health care providers and suppliers enrolled in government programs adopt formal compliance plans. However, with the passage of the Patient Protection and Affordable Care Act, this recommendation is now a condition of enrollment in Medicare. This means that not only will all providers be required to have compliance plans in place, but also the plans must contain certain core elements. The exact language found in Subtitle E, §6401(7) states:

(A) On or after the date of implementation determined by the Secretary under subparagraph (C), a provider of medical or other items or services or supplier within a particular industry sector or category shall, as a condition of enrollment in the program under this title, title, XIX, or title XXI, establish a compliance program that contains the core elements established under subparagraph (B) with respect to that provider or supplier and industry or category.

The law gives the Secretary of DHHS, in consultation with the OIG, the ability to establish the core elements for the compliance programs and the timeline for requiring the implementation of the program. All providers enrolled in government programs, from solo practitioners to multi-campus hospitals, will have to meet this requirement! While the Secretary has not yet published a time-frame for the required compliance, now is a good time to start working on a compliance program if you don’t have one, or make sure your current program is up-to-date.


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Chance McDaniel
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