CCA compliance team introduces new Physician Services Program

The CCA Compliance team is launching a new program to reflect its best-in-class commitment, focusing on continuously improving and enhancing its regulatory compliance oversight across all CCA business entities.

To pinpoint one area of this continuous program enhancement, the new CCA Compliance Physician Services Program will focus on further development of enterprise-wide provider auditing and monitoring oversight. The program:

• Contributes to provider partnership and education efforts,
• Assists in ensuring compliance with the Centers for Medicare & Medicaid Services and other statutory requirements in key operational areas,
• Informs further audits as appropriate,
• Incorporates a variety of audit methods (auditing/monitoring), written reports presenting key findings, and proposed corrective action plan recommendations.

While the items listed above target enterprise-level outcomes, CCA Compliance also focuses on the individual provider, being mindful of the need to support education and potential training needs. To this end, our reinvigorated program also considers:

• Understanding the individual’s need for a level of autonomy in completing their task,
• Ensuring competencies of each provider in the areas reviewed (e.g., documentation, coding accuracy),
• Partnering in education to ensure accuracy and remediation as warranted

As a first step, providers may refer to the CCA Outpatient Evaluation & Management Services New & Established Patient Encounter Requirements, available for reference and download here.

It is based on an American Medical Association reference guide and aids providers in the selection of levels of service for new and established outpatient encounters. It reflects code changes that became effective January 1, 2021.

For more information about CCA’s Compliance Program for Massachusetts and Rhode Island, please refer to the Compliance and Fraud, Waste & Abuse Programs section in our provider manuals.

• Provider Manuals: Massachusetts
• Provider Manual: Rhode Island

Please reach out to our compliance team with your questions or concerns: