Written standards of conduct — one of the seven elements of compliance

by • November 1, 2007 • UncategorizedComments Off on Written standards of conduct — one of the seven elements of compliance2698

• The Gist: Attorneys may be very interested in a healthcare organization’s code of conduct (CoC). Any organization that bills Medicare and Medicaid would need to have a code of business conduct (CBC), and any healthcare organization that is under a Corporate Integrity Agreement would need to have a CBC. Most legal nurse consultants who do “general” work probably would not be interested in a business’ (CoC), but LNCs who perform compliance audits or who serve as compliance officers would be most interested in a company’s business or ethical codes of conduct.

Seven elements for compliance programs

• Standards and procedures

• Oversight.

• Education and training.

• Monitoring and auditing.

• Reporting.

• Enforcement and discipline.

• Response and prevention.

ESSAY By Angela L. Tobias, RN, BSN, MSHSA, LNCC

© 2007 The Medical-Legal News and Angela Tobias

Ethical codes of conduct (standards of conduct) provide organization employees with guidance regarding proper business behavior. From policies concerning employee acceptance of gifts and gratuities to identifying conflicts of interest, business codes of conduct (CoCs) can set the right ethical tone for the organization.

A CoC defines what is acceptable concerning most common business transactions. Whether you call it a business CoC or an ethical CoC, it must define what constitutes acceptable business behavior and then outline guidelines for honest and ethical business practices emphasizing compliance with all applicable laws, rules and regulations governing the organization’s operation. It must be written (usually at an eighth grade level) so that employees can understand and identify with it, and include guidance for the most common business practices.

The CoC sets the tone for proper decision making and supports organization performance in basic business relationships. It is intended for employees, vendors, volunteers and governing body members and must be written to address guidance for acceptable, honest and ethical practices within the organization. Ethical CoCs must have the support of the organization’s administration and governing board and reflect the organization’s culture and corporate identity. An endorsement from the organization’s chief executive officer is very important in emphasizing the organization’s intent for doing what is right.

Ethical CoCs cover a multitude of business behaviors and demonstrate proper ways (honest, ethical, compliance with laws) of conducting business.

Examples of proper business conduct might include, naming a few, guidelines for:

1. Accepting gifts only if they are of nominal value (less than $25).

2. Identifying and reporting conflicts of interest within the organization.

3. Defining quality of care within the organization and delineating the organization’s commitment to providing quality of care or services in all areas of the operations.

4.Guiding business transactions with providers.

5. Emphasizing the organization’s commitment to providing accurate documentation and timely billing for services provided.

6. Giving guidance regarding how to address coding variances or billing questions before the bill is sent out.

The CoC may not be able to address every aspect of organization business but should cover the most common areas of concern. It is a “fluid” document and must be reviewed frequently, at least annually, and revised as necessary to address each new area of concern. The key is to define proper behaviors and emphasize “zero tolerance” for unethical behavior, fraudulent activity or waste and abuse.

More information concerning the Office of Inspector General’s expectations concerning business CoCs can be found at http//oig.hhs.gov, and referencing guidance for hospitals (by selecting the guidance practices menu) or by looking at examples of published corporate integrity agreements found in the fraud prevention menu. •

Angela L. Tobias, RN, BSN, MSHSA, LNCC is co-owner of Nightingale Consulting, LLC a legal nurse consulting firm located in Dalton, Ga. She has served as a hospital CEO and corporate compliance officer;angietobias@catt.com.

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