Suffering from Rule Overload?

Welcome back to Compliance University — Class is now is session! This month I will begin a “maxi-series” of articles to address a major problem home care providers face: Rule Overload.

Let's listen to the home care providers' lament: “Help! We must track hundreds of reimbursement rules, OSHA rules, CLIA rules, anti-fraud rules, privacy rules, security rules, government rules and private payer rules! It's too much to monitor, let alone conquer. We're at the end of our rope!”

Clearly, these providers suffer from that new malady “Rule Overload.” Perhaps HIPAA has elevated the rule-overload problem to epidemic proportions by imposing specific and detailed regulatory obligations with firm deadlines for compliance.

While it is true that new reimbursement rules also have firm deadlines for enforcement, the reimbursement rules tend to be communicated only one or two at a time, so the accumulated stress from Rule Overload may go unnoticed.

And, while it is also true that anti-fraud rules tend to hit in bigger clumps, these rules frequently are colored in shades of gray, with subtle dangers that, ironically, make it easier to push them to the back of our heads to be dealt with later. In addition, anti-fraud compliance programs have been optional, not mandatory, and have not had deadlines by which mandatory compliance programs were required. This has led many providers to put off focused compliance efforts.

HIPAA, with its firm rules and deadlines, has hit providers differently. As a result, a majority of providers who have approached HIPAA compliance from the perspective of “learning the rules” now suffer from Rule Overload.

Some HIPAA rules conflict with existing operations. Some rules are resisted or misunderstood by personnel. Different advisors offer different advice about how to apply the rules. Rules interfere with making money. Efforts to focus on the HIPAA rules take precedence over efforts to comply with reimbursement rules (which then leads to reimbursement problems) or the anti-fraud rules (which then leads to OIG problems). Rules, rules, rules.

The ROPE Ladder

However, there is a solution: If you are at “the end of your rope,” then it is time to climb a ROPE ladder.

What is ROPE? Rule Overload Prevention and Elimination. A ROPE ladder, quite simply, is a way to eliminate your existing Rule Overload and prevent it from recurring. We may summarize the secret to climbing a ROPE ladder like this: It's all about the system.