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Thread: medicare compliance

  1. #1

    Default medicare compliance

    AAPC: Back to School
    Can anyone advise me on having a medicare compliance plan. Is it mandatory for our practice to have a written policy in place or just vouluntary at this point. I have heard conflicting reports and one that said it wasn't mandatory until 2011. If anyone has the answer to this can you please provide me with your resource?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    7) COMPLIANCE PROGRAMS- (Section 6401)

    `(A) IN GENERAL- 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.

    `(B) ESTABLISHMENT OF CORE ELEMENTS- The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall establish core elements for a compliance program under subparagraph (A) for providers or suppliers within a particular industry or category.

    `(C) TIMELINE FOR IMPLEMENTATION- The Secretary shall determine the timeline for the establishment of the core elements under subparagraph (B) and the date of the implementation of subparagraph (A) for providers or suppliers within a particular industry or category. The Secretary shall, in determining such date of implementation, consider the extent to which the adoption of compliance programs by a provider of medical or other items or services or supplier is widespread in a particular industry sector or with respect to a particular provider or supplier category.'.


    Section 6102 addresses the compliance plans for a SNF

    Some of the components of a compliance program can be found in the federal regs...


    I think the date is still "up in the air" for provider groups. I was reading this the other day...

    "The requirements as to other providers and suppliers, however, are largely undefined. As noted above, there is no specific implementation timeline for the development or implementation of these compliance programs. Instead, Congress has left the establishment of core compliance program elements and implementation deadlines to the discretion of HHS."

    Pages 3-4


  3. #3

    Default medicare compliance

    So your saying that as of now it is not mandatory by law that our practice have a medicare compliance plan in place. Although it is strongly reccomended. Your also saying that if this should became mandatory the date as to when is not set in stone? Just want to make sure i understand what you saying.

  4. #4
    Join Date
    Apr 2007
    North Carolina


    A compliance plan is unavoidable (as it should be). Putting one in place sooner than not is my recommendation. What I'm not certain of is when it will become mandatory. Is anyone?

  5. #5


    Thank you i appreciate your help.

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