The Affordable Care Act (ACA) identifies requirements related to provider compliance with fraud, waste, and abuse laws that have been enacted to protect consumers. Research three of these requirements and describe the corresponding measures that your health care organization has initiated, or could initiate, to comply with the ACA. Support your analysis with a minimum of two peer-reviewed articles. Purchase the answer to view it

The Affordable Care Act (ACA), also known as Obamacare, was signed into law in 2010 with the aim of improving access to quality healthcare for individuals and reducing healthcare costs. One important aspect of the ACA is its focus on provider compliance with fraud, waste, and abuse laws. This paper will discuss three requirements related to provider compliance with these laws and explore the measures that healthcare organizations can initiate to comply with the ACA.

Requirement 1: Implementing Effective Compliance Programs
One requirement under the ACA is the implementation of effective compliance programs by healthcare organizations. These programs are designed to identify and prevent fraud, waste, and abuse. According to Bame et al. (2015), an effective compliance program should include the following key elements: written policies and procedures, designated compliance officer, employee education and training, effective communication channels, internal monitoring and auditing, and prompt response to detected offenses.

To comply with this requirement, healthcare organizations can initiate several measures. Firstly, they can develop written policies and procedures that clearly outline the organization’s commitment to preventing fraud, waste, and abuse. These policies should specify the roles and responsibilities of staff members and provide guidance on identifying and reporting potential violations. Secondly, organizations can designate a compliance officer who is responsible for overseeing and implementing the compliance program. This individual should have the necessary knowledge and authority to effectively fulfill their role. Thirdly, organizations should provide regular education and training to employees to ensure that they are aware of fraud, waste, and abuse laws and understand their obligations to report any suspected violations. Finally, healthcare organizations should establish effective communication channels, such as anonymous reporting hotlines, to encourage employees, patients, and other stakeholders to report any potential fraudulent activities. Internal monitoring and auditing processes should be implemented to assess the effectiveness of the compliance program and identify any areas of concern, which can then be promptly addressed.

Requirement 2: Reporting and Returning Overpayments
Another requirement under the ACA is that healthcare providers must report and return any overpayments within 60 days of identification. According to Gibbs et al. (2016), overpayments refer to funds that healthcare providers have received in excess of the amount they are entitled to receive. These overpayments may result from coding errors, billing mistakes, or other administrative errors. The ACA requires healthcare providers to exercise reasonable diligence to identify overpayments and take appropriate actions to return them.

To comply with this requirement, healthcare organizations can initiate several measures. Firstly, they can implement robust billing and coding compliance processes to identify and rectify any errors that may result in overpayments. Regular audits should be conducted to ensure that billing and coding practices are accurate and compliant with legal requirements. Secondly, organizations should establish mechanisms to promptly detect and track overpayments. This can be done through the use of data analytics tools and regular reviews of financial records. Thirdly, healthcare organizations should establish clear protocols for addressing identified overpayments, including a timeline for investigation, notification, and refund. This will ensure that overpayments are promptly reported and returned within the required 60-day period.

Requirement 3: Prohibition of Certain Payments
The ACA prohibits healthcare providers from making certain payments to individuals or entities for patient referrals. The anti-kickback statute, which is a federal law, prohibits the exchange of anything of value in return for patient referrals. The Stark Law, another federal law, prohibits physicians from referring patients to entities with which they have a financial relationship, unless a specific exception applies. These laws are designed to prevent financial incentives that may influence healthcare providers’ medical decision-making and potentially result in unnecessary services or higher costs.

To comply with this requirement, healthcare organizations can initiate several measures. Firstly, they can establish robust compliance processes that include a thorough review of financial relationships with referral sources. These processes should assess the nature and extent of financial relationships and ensure that they comply with the anti-kickback statute and the Stark Law. Secondly, healthcare organizations should provide education and training to staff members, especially those involved in patient referrals, about the laws and regulations related to prohibited payments. This will help raise awareness and ensure that employees understand their obligations to comply with these laws. Thirdly, organizations should implement monitoring mechanisms to identify any potential violations of the anti-kickback statute or the Stark Law. These mechanisms can include regular internal audits, data analytics, and the use of external resources for compliance reviews. Prompt action should be taken to address any identified violations, including the termination of non-compliant relationships and the implementation of corrective measures.

The ACA has established requirements related to provider compliance with fraud, waste, and abuse laws. Healthcare organizations can initiate several measures to comply with these requirements, including implementing effective compliance programs, reporting and returning overpayments, and prohibiting certain payments. By implementing these measures, healthcare organizations can contribute to the overall goal of the ACA to improve access to quality healthcare and reduce healthcare costs.

Do you need us to help you on this or any other assignment?

Make an Order Now