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Ancillary Billing Services
Compliance Program
Fee For Service
Full Assignment
Information Center
Literature
Part B Program Analysis
Sales Team
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ProClaim
Compliance
Program
ProClaim recognizes that
billing companies are becoming a vital segment of the
national health care industry. Health care providers
are increasingly relying on billing companies to assist
them with processing claims in accordance with applicable
statutes and regulations. Additionally, health care
providers are consulting with billing companies to provide
timely and accurate advice regarding reimbursement
matters, as well as overall business decision making.
As a result, we recognize the need for implementing a
corporate compliance plan designed to assure internal
safeguards against fraud and abuse and provide a support
system to the clients who utilize our services.
ProClaim's
compliance plan is designed to establish a culture within
our company that promotes prevention, detection, and
resolution of instances of conduct that do not conform
to Federal, State, and private payor health
care program requirements. The compliance plan also
serves as our ethical and business policies code of
conduct. In practice, the compliance program will
effectively articulate and demonstrate our commitment to
legal and ethical conduct.
Specifically, the compliance program will
guide our governing body (e.g., boards of directors or
trustees), chief executive officer (CEO), managers,
billing and coding personnel, and other employees in the
efficient management and operation of the company. These
guidelines are especially critical as an internal quality
assurance control in reimbursement and payment areas
where claims and billing operations are often the source
of fraud and abuse; and therefore, historically have been
the focus of Government regulation, scrutiny, and
sanctions. This plan has been developed for the guidance
and protection of ProClaim, Inc., our officers, employees,
and, ultimately, our clients.
Additionally, ProClaim employs the services
of an external audit firm to semi-annually review random
claims and ProClaim's processes.
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