In the January issue, we covered Development of Compliance Policies and Procedures and Designation of a Compliance Officer
If you missed that issue, you can find it and all prior newsletters here.

This month we will cover Conducting Effective Training and Education and Developing Effective Lines of Communication

Conducting Effective Training and Education Compliance training of all department personnel is an important component of any program. The training should be specific to job duties. The OIG recommends that your training be done at least annually and be broken down into two sessions. The first session, the "general" session, should be required for everyone within your organization. It should highlight your organization's commitment to remaining compliant and should include information on any new regulations, fraud & abuse statutes, as well as your organization's standards of conduct. The second session, "coding and billing" training, should include anyone involved in the billing process. During this session you should include documentation expectations, government and private reimbursement requirements, improper alterations to documents, etc...

Remember to keep records of attendance and of course, content.

Here at Systems Design we have several meetings throughout the year to discuss new billing and coding issues. As part of our commitment to you, our staff takes regular outside training courses so that we can remain knowledgeable in the face of an ever changing industry.

Developing Effective Lines of Communication To be effective, your organization's Compliance Officer must remain readily accessible. Employees should be encouraged to seek his/her advice in the event of confusion regarding policy and procedures. Questions and responses should be documented and dated and, if appropriate, shared with the rest of your staff. In the event of outright fraud or abuse employees must be certain that they can come forward without fear of retaliation. You should develop several independent methods of reporting violations (hot line, e-mail, etc.) so that there is no possibility that reports will be diverted by supervisors or coworkers.

In future issues we will discuss:

• Internal monitoring and review
• Responding appropriately to misconduct
• Enforcing disciplinary standards through well published guidelines.

On December 23, 2005 CMS released the new Condition Code List. As well as the addition and deletion of some codes, they have also clarified the use of the modifiers, which now are known as the transportation indicators. Because these indicators allow us to comment on medical necessity before the denial stage, we are cautiously optimistic regarding their use. CMS has ordered the carriers to begin to accept the condition codes and new modifiers by March 27, 2006.

As many of you might have heard, on February 2, 2006, the Medicare carriers were instructed by CMS to immediately freeze all ambulance payments until further notice. The freeze was ordered because CMS had provided incorrect 2006 allowables to the carriers. Well, good news! The corrected rates were provided to the Medicare carriers on February 6, 2006 and they were ordered to begin using these rates to process claims immediately. CMS stated that there should be minimal disruption in your claims processing. They also stated that they will be issuing recoupment requests for any overpays that might have happened prior to February 2, 2006. We of course will keep you informed.

Gina Behrens
- Account Manager

Gina (pronunced Geena) was introduced to you in our September 2005 newsletter. At that time, she had come to work at Systems Design part time as a general clerk and resident Spanish speaker. We are happy to announce that because of our continued growth and her outstanding performance, Gina has been promoted to Account Manager status and will be working full time.

When Gina is not at Systems Design, she enjoys clamming, crabbing and spending time with her son Herman.

One day a man comes home from work to find total mayhem at home. The kids were outside, still in their pajamas, playing in the mud and muck. There were empty food boxes and wrappers all around. As he proceeded into the house, he found an even bigger mess.

Dishes on the counter, dog food spilled on the floor, a broken glass under the table, and a small pile of sand by the back door. The family room was strewn with toys and various items of clothing, and a lamp had been knocked over.

He headed up the stairs, stepping over toys, to look for his wife. He was becoming worried that she may be ill, or that something had happened to her. He found her in the bedroom, still in bed with her pajamas on, reading a book.

She looked up at him, smiled, and asked how his day went. He looked at her bewildered and asked, "What happened here today?"

She again smiled and answered, "You know every day when you come home from work and ask me what I did today?"

"Yes," was his reply.

She answered, "Well, today I didn't do it!"

Although we always welcome your phone calls, there are times you may wish to contact us via e-mail.

Gina Behrens	GinaB@SystemsDesignNW.com
Shelley Brewington	ShelleyB@SystemsDesignNW.com
Lori Christenbury	LoriC@SystemsDesignNW.com
Cris Connors	CrisC@SystemsDesignNW.com
Judy Dunn	JudyD@SystemsDesignNW.com
Tammy Flanagan	TammyF@SystemsDesignNW.com
Carol Green	CarolG@SystemsDesignNW.com
Laurel Hoch	LaurelH@SystemsDesignNW.com
Kim Mayes	KimM@SystemsDesignNW.com
Lois Pierce	LoisP@SystemsDesignNW.com
Lisa Rogalsky	LisaR@SystemsDesignNW.com
Sue Schmitt (Holler)	SueS@SystemsDesignNW.com
Juls Smith	JulsS@SystemsDesignNW.com
Cindy Tomeo	CindyT@SystemsDesignNW.com
Susan Wytko	SusanW@SystemsDesignNW.com
Roger Zegers	RogerZ@SystemsDesignNW.com