It's a Wrap: Finalizing the 2019 Compliance Year

As the end of the year rapidly approaches, many people use lists to make sure they accomplish all their tasks.Below is a list a compliance officer may want to check one last time.

• For Medicaid providers in New York State, prepare to do your annual compliance certification. You must certify if you expect to order at least $500,000 in Medicaid services or expect to receive at least $500,000 in Medicaid benefits in a 12-month period. The certification is done on-line at the NYS OMIG website (www.omig.ny.gov/). Providers should have applicable Federal Tax Identification numbers and NPI numbers available when completing the form. The compliance officer and a certifying official (typically to whom the compliance officer reports) complete the form.The OMIG notifies providers when the portal opens, usually in early December. The form must be completed on or before December 31st.
   
• For Medicaid providers in New York State who receive at least $5 million in Medicaid funds in a 12-month period, the federal Deficit Reduction Act (DRA) certification must also be completed by December 31st. This form is available on-line at the NYS OMIG website. Similar to the OMIG certification, you should have Federal Tax Identification numbers and NPI numbers available when completing the form. The compliance officer and a certifying official complete the form.
   
• Finalize your 2020 compliance work plan for presentation to the Board or Corporate Compliance Committee.
   
• Summarize the accomplishments from your 2019 compliance work plan including any self-disclosures and successful governmental audits.  Audits are key to a successful compliance program.  Does your 2019 audit effort demonstrate genuine provider effort to identify remuneration concerns in high risk, high volume billing areas?  It is also important to ensure your 2020 audit effort does not rotelessly duplicate audit areas found to be devoid of risk.  Audits are not an exercise in proving perfection.  Audits are intended to identify and remediate billing risk areas. Static audit areas from year to year fail to reflect an active, robust and effective compliance plan.
   
• What if you did not address all of your 2019 work plan items?  It is OK.  As Chief Compliance Officer for Kaleida Health, I generally addressed approximately one-half of the work plan items that appeared on the work plan in January of the calendar year.  The reason:  other urgent compliance matters.  The important point about unaddressed items is……they are unaddressed items.  You have limited resources that require a constant reprioritization of compliance matters.  So, do not simply delete the unaddressed items.  Provide a response for the unaddressed items. It may be that policy, rule or regulation mitigated the original concern.  It may be other more urgent matters required redirection of scarce resources.  It is important for the Board to be made aware of your scarce resources and coordinate with senior management. It is also important to ensure those more urgent matters that displaced some original work plan items also are memorialized in the year end work plan.  Work plans are fluid, evolving documents and not etched in stone.
   
• Many health care providers prohibit accepting gifts and gratuities from vendors.  However, that does not stop the vendors from sending gift baskets or other types of holiday recognition.  It is a good time for the compliance officer to send a reminder to employees that the Code of Conduct prohibits employees from accepting gifts from vendors.  The compliance officer may go a step further and send a letter or e-mail to vendors reminding them that they have agreed to abide by your company's code of conduct as part of their contract and will adhere to the no-gift policy.
   
• Create a tickler calendar for 2020 so that you check in with various departments for mandatory filings. This may include checking with the Finance Department for abandoned property filing reports in early March. If you are a tax-exempt organization, you may want to review IRS form 990. This form is due on the 15th of the fifth month following the close of your fiscal year.
   
• Commit to an educational event for you and your compliance staff for 2020. This may be an off-site seminar or workshop or you may bring an outside speaker to your site.
   
• Good luck.  You did great work in 2019.  Compliance work is some of the most complex work in health care.