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What is healthcare compliance?

No matter your specialty or the size of your practice or facility, there are healthcare compliance concerns that all medical organizations face. From eliminating cloned electronic health records and poor physician documentation to following the Emergency Medical Treatment and Active Labor Act (EMTALA) and Stark Law and Anti-Kickback Statutes, health care organizations must be compliant with changing health care trends, guidelines, laws, and government regulations to minimize their risk.

To stay out of harm’s way from government scrutiny and liability risk, your practice or facility can benefit from a medical compliance plan and the services of a health care compliance officer. It’s the best way to ensure your claims and processes are clean and compliant with government and payer requirements, to decrease your risk of malpractice claims and insurance fraud and abuse, and to save you from costly lawsuits.

Why Do Health Care Organizations Need a Compliance Officer?

Medical practices need someone who can develop, organize, manage, and direct the functions of a compliance department: a health care compliance officer. A compliance officer makes sure all policies and procedures of a health care system are accurately maintained and organized, and calls for changes when they need to be made. They understand the nature of the compliance-related risk, where it occurs, and how to manage it by balancing compliance costs against the business risk.

Become a Healthcare Compliance Officer

AAPC offers the Certified Professional Compliance Officer (CPCO™) credential to help address the ever-growing compliance requirements of government laws, regulations, rules, and guidelines.

This healthcare compliance certification demonstrates that you understand the key requirements needed to effectively develop, implement, and monitor a health care compliance program for your practice based on governmental regulatory guidelines. This includes being knowledgeable in compliance reviews, audits, risk assessments, and staff education and training. With the CPCO™, you’ll obtain expertise in areas such as:

  • Office of Inspector General (OIG) compliance guidance
  • Health care fraud and abuse laws (False Claims Act, Stark Laws, and Anti-kickback Statute, etc.) including associated penalties
  • Provider Enrollment and Chain Ownership System (PECOS) verification
  • How the Affordable Care Act will affect medical practices
  • Health Insurance Portability and Accountability Act (HIPAA), EMTALA, and Clinical Laboratory Improvement Amendments (CLIAs)
  • Handling investigations, including self-disclosure protocols
  • Requirements under Corporate Integrity Agreements (CIAs) and Certificate of Compliance Agreements (CCAs)
  • Government investigative audit programs (for example, recovery audit contractors (RACs), Zone Program integrity contractors (ZPICs), State Medicaid Fraud Control Units (MFCUs))
  • Risk areas such as receiving gifts or gratuities, conflicts of interest, use of Advance Beneficiary Notices (ABNs), teaching physicians guidelines, and incident-to services

If you are a certified healthcare compliance officer and want to take your expertise, credentials, and career to the next level, consider becoming a CPCO™ through AAPC. You already have the background and know how to follow proper coding, billing, and claim requirements, so you have a jumpstart on understanding government rules and regulations in health care. Find out more here.

Prepare for certification and a career in healthcare compliance

Validate your knowledge, skills, and expertise with healthcare compliance certification