Compliance Program Guidance 
Compliance Program Guidance assists healthcare providers and their agents
in developing effective internal controls that promote adherence to not only
the applicable federal and state laws, but also the program requirements of
federal, state and private health plans.
Billing companies are becoming a vital segment of the national healthcare
industry. Healthcare providers are increasingly relying on billing companies
to assist them in processing claims in accordance with applicable statutes
and regulations. Additionally, healthcare providers are consulting with billing
companies to provide timely and accurate advice regarding reimbursement matters,
as well as overall business decision-making.
The benefits of a compliance program provide a mechanism that brings the public
and private sectors together to reach the mutual goals of enhancing the quality
of healthcare while reducing the costs with improved operational quality and
decreased incidences of fraud and abuse. The specific benefits are as follows:
- The formation of effective internal controls to assure compliance with federal regulations, private payer policies and internal guidelines.
- Improved medical record documentation.
- Minimizing the loss to the government from false claims with early detection and reporting, thereby reducing the provider's exposure to civil damages and penalties, criminal sanctions and administrative remedies, such as program exclusion.
