Good evening listeners, hope you all had a lovely day. This evening we are blessed to have Kurtis McJr Apollo who is the healthcare compliance officer from the Transcend Referral Hospital located along Mars Avenue. As we all know compliance officers have one the most important duties to perform in order to ensure that everything is on track. Mr Apollo, welcome.
Thank you; am honored.
What are your roles and responsibilities as the compliance officer at the Transcend Referral Hospital?
Delegate your assignment to our experts and they will do the rest.
Compliance officer roles can also be referred to as compliance manager. My role as a compliance officer is to ensure that the hospital does not fail to conduct its operations in relation to the complete compliance of all the international and national law and principles in relation to healthcare services as well as the internal and personal standards (Walters, n.d).
What is the process for a patient to file a complaint?
I have reasons to believe that we all are up to date with the process of filing a complaint against the health care institution or provider. All the same, I will go through it so that those who are unaware of the process may know and act as a reminder to those who know it. Every person on this earth has a right to file a complaint in contradiction to any received healthcare services if in any case they feel dissatisfied or their privacy was breached. Filing a complaint is very simple since it only requires writing a fax, e-mail, or a later. Also making a phone call can apply after which a reply would be received within the shortest time possible. In case, the complaint is not handled as expected by the complainant or is handled without the proper attention that it required, you are allowed to file another complaint this time not with the Hospital Administration but with the administrative authority which is responsible for granting health care practice permit (Mluvtecesky.net, 2018).
How do you deal with civil versus criminal complaints?
Civil cases are usually those which involve disputes between the complainant and an organization or a person. For instance, a patient sues the doctor for poor medical services. Criminal cases, on the other hand, are cases which involve the rules of the society and usually involve the participation of the local police, for instance, selling illegal or expired drugs. Handling civil cases is easier compared to a criminal case which is more complex since death may be involved. Civil is handled individually and criminal is handled societally.
What moves an internal compliance issue to have to be reported to law enforcement, CMS, or a health plan?
The Center for Medicare and Medicaid Services (CMS) has the power to do investigations in case of a complaint and incorporation with the Health Insurance Portability and Accountability Act (HIPAA) standards review for compliance. This body, CMS usually comes in to investigate operating rules, code sets, transactions and unique identifiers among others. CMS usually does this on Health and Human Services (HHS) behalf (CMS.gov, 2018).
What are the most important or common risk management issues for your organization?
There are numerous common risks faced by medical staff within their everyday operations. For instance, the management is in most cases fatigued by alarms, violence and acquired infections among others. What is more, the management faces other risks such as cyber risks, telemedicine, obesity epidemic, environmental pollutants and many more risks (ACE Group, 2015).
What type of accreditation issues do you work on?
The compliance role is growing wider every day within the healthcare institutions, new and variety of roles have to be taken upon in areas like quality assurance and accreditation. The way of managing these responsibilities in addition to the structure of the organization would be the determiner of success in my duty.
Thank you very much but before you leave there are a few more question which have been asked by our listeners.
Go on.
What changes would you like to see within the reporting structure or in regulations for the hospital?
Effective change can possibly be characterized by the introduction of fresh changes, and unfreezing the old habits. In any healthcare institution, change may be rare, occasional, continuous or sporadic. Predictable changes usually give time to incorporate and prepare for it, unlike unpredictable change which is more complex to effectively respond to it. Since healthcare changes transpire so rapidly, it is hard to predict them. In that case, it is hard to say the change that I would like to see in the reporting structure. Even if I had one in mind the other employees would need to understand why the need for it and the effects it may bring along.
What is the proper reporting of violations of accepting gifts that value more than the amount allowed from vendors? What are the potential consequences?
Gifts can take dozens of forms including books, meals, stethoscopes, travel funds and entertainment among others. It is important as a medical practitioner to understand that these gifts and many others whether small or large usually creates self-serving bias and obligation feelings which may have a negative impact towards the care of patients (Community Catalyst, 2013). Reporting such cases in most cases is in accordance with the institution laws. For instance for Duke University (a medical school) in case of such an incidence, then the Duke University Health System (DUHS) Compliance Reporting (Non-Retaliation/Non-Retribution) Policy would be applied (Community Catalyst, 2013). Potential consequences of accepting gifts from vendors may be severe to either side which may include fines or loss of medical practice license or permit for operating a pharmacy among other potential dangers.
How would you go about revising policies and procedures in the event of a miscommunication between staff about overcharging or undercharging for services rendered in physical therapy?
In most cases overcharging comes when the patient is not covered by either Medicaid or Medicare or any other health insurance coverage. Also overcharging may come in as a result of expensive drugs. Revising procedures and policies of a health institution require the board to do it and change it substantially.
How would you handle a situation where a member of the therapy team overheard a patient being concerned about getting the wrong medications and they are afraid of having repercussions from nursing toward the therapy team if it is reported?
In such a case then the patient would come first and then my colleagues. My advice to the patient would be to refer him/her to another hospital and then encourage them to first report the incident before starting another therapy at the referred hospital.
References
ACE Group. (2015, June 1). 11 Critical Risks Facing the Healthcare Industry. Risk & Insurance . Retrieved from http://riskandinsurance.com/11-critical-risks-facing-the-healthcare-industry/
Centers for Medicare and Medicaid Services (CMS).gov. (2018). Enforcement and Compliance Overview . Retrieved from https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Enforcements/index.html
Community Catalyst. (2013). Conflict of Interest Policy Guide for Academic Medical Centers and Medical Schools. COI Toolkit on Gifts, Meals, and Entertainment . Retrieved from https://www.communitycatalyst.org/resources/publications/document/CC-Toolkit-6-Gifts-FINAL.pdf
Mluvtecesky.net. (2018). Procedure for Filing a Complaint against Health Care Received . Retrieved from http://mluvtecesky.net/en/introduction/health_care/complaint_healthcare
Walters, R. (n.d). The role of a compliance officer . Retrieved from https://www.robertwalters-usa.com/career-advice/the-role-of-a-compliance-officer.html
