Compliance Corner

Ophthalmic Compliance Has a Broad Reach

Laws, regulations and standards impact virtually every aspect of the ophthalmology practice, from OR protocols to discussions at the water cooler.

By Jolynn D. Cook, RN, COE, CASC

Office managers and administrators have a natural tendency to be compliant individuals because of their educational background and experience. However, those new to the role of administrator in an ophthalmic practice should understand the significance compliance has upon the day-to-day operation of the practice.

The standards/laws that come to mind when an administrator thinks about compliance as it pertains to heath care, and specifically to ophthalmology practices, include: Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens and the Health and Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.

Of course, as participants in federally funded programs such as Medicare and Medicaid, the practice is required to comply with regulations set forth in any contractual relationship with payors. Today, a prudent administrator must recognize that compliance in the ophthalmic practice has a much greater reach.

■ OSHA training must be offered to every employee at the time of hire and then annual refreshers are required. Be sure that any employee at risk for exposure to bloodborne pathogens is offered (at no cost to the employee) the Hepatitis B vaccine within 10 days of assignment where a potential risk exists. It does not matter whether you have one or 100 employees; this law applies to any employee who has exposure risk.

■ Harassment training (Title VII of the Civil Rights Act of 1964) should be offered at the time of hire and an annual refresher given to everyone. Not only is this the right thing to do, but it helps employees understand that inappropriate conduct is unacceptable from the day they first enter the office. Employees need to know that inappropriate behavior can be very serious and potentially put the practice at risk of supporting an alleged hostile work environment. It is also important that physicians and managers understand that there is a “line” that should not be compromised in a professional setting. In general, developing and complying with a zero tolerance policy on harassment reflects a commitment to providing a work environment free from harassment of any type. A prudent administrator should never presume that an employee understands this intuitively.

■ IT security is a growing area where compliance is an evolving topic as practices transition to electronic health records. At the very least, the administrator should carefully consider a “cyber” insurance policy. Meeting with an agent is a great way to develop an understanding of the risks associated with EMR. Employees must receive initial training regarding passwords and protected health information. It is advisable to include this topic in the initial training and any refresher courses offered by the practice.

■ HIPAA compliance information must be provided upon hire and reviewed annually. A signed document should be obtained at the conclusion of training and maintained in the compliance files.

■ Medicare/Medicaid compliance extends to following the rules set forth by any programs a practice actively participates in or with, such as Medicare/CMS. If you accept assignment from Medicare, then the practice has agreed to “play by the rules” set forth by CMS. The practice can exercise the right to withdraw from the Medicare program, but in most private practices this may not be advisable.

■ Insurance (payor) contracts with various payors often appear complicated. Yet these must always be understood by anyone involved with the billing department to ensure compliance with the terms agreed upon in the contract. Avoid any attempts to “get around” the terms and conditions of the agreement. It may be better to simply dissolve the contract, rather than attempting to find ways to be creative or “get around” agreed upon terms.

■ One final thought. Help is available. Professional consultation is the safest way to develop a compliance program. It is always a good idea to seek the help of legal counsel or any professional organization or consultant who can help and advise the practice on these important matters. Available resources for reading and study to help you to develop a foundation of knowledge to guide you and your physicians through this may also be very helpful if you are reviewing, revising or beginning a compliance program within your practice for the first time. OP

Ms. Cook is the Administrator of the Laurel Eye Clinic and the Laurel Laser & Surgery Centers. A Certified Ophthalmic Executive and a Certified Administrator Surgery Center (CASC.), Ms. Cook is a registered nurse and also has a degree in Health Care Administration.