click here to return home Compliance Support Service’s role in Compliance Programs for Physician Practices
CREDENTIALING SERVICES Managed care support services provides the physician practices with on going tools and reports to inform
Compliance Support Service’s role in HIPAA Compliance is to assist our physician groups with tools and resources to implement and monitor HIPAA Privacy Policies
Compliance Support Services (CSS)

CSS Functions:

 
Compliance Plan Development
 
Assist the Practice in developing a plan for complying with applicable federal and state statutes, regulations, policies and procedures governing Medicare and Medicaid billing and reimbursement matters. Assiste the Practice in keeping their Compliance Plan current and updated.

Compliance Plan Implementation
 

Assist the Practice in developing processes, procedures and business practices to effectively implement the Plan and adhere to Government Regulations. 
   
Compliance Hot-Line Voice Mail
 
Establish and maintain a dedicated telephone line to receive calls. Implement a process to protect the anonymity of complainants. 

Training Services
 
Provide annual training sessions for the Practice on issues such as the fraud and abuse laws for claim development and submission process; a review of Medicare requirements relating to documentation, charge entry and coding; and the consequences for failing to comply with applicable laws. Conduct all new employee training on a monthly basis.
 
Auditing
 
Yearly audit of Medicare and Medicaid claims regarding coding practices, claim submission and reimbursement.

Employee/Vendor Screening
 
Conduct a screening of employees and vendors by reviewing the DHHS/OIG Cumulative Sanction Report and a source for state or local background check.

Consulting
 
Question and Answer service for all compliance issues. Will provide documentation to support TSMG's response.

Newsletter
 
Prepare and distribute a monthly newsletter to update and educate CSS Compliance Member Groups. Information in the newsletter will include a summary of newly released Compliance Information and Health Care Fraud Alerts issued by the Office of the Inspector General.
 

Joyce Kyle, CCP
Director of Compliance
260-422-7524
Jkyle@tristatemed.com 

 

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Tri-State Medical Group
Director of Operations Lana Lowe
One Canal Place, Suite 200
709 Clay Street
Fort Wayne, IN 46802
(260)426-1321
Fax (260)426-0270
Lana@tristatemed.com