Compliance as defined by the Office of Inspector General (OIG) has taken on a very complex nature. June of 1999 the OIG issued their definition of compliance for the Durable Medical Equipment Supplier.

There are 7 elements that are broken into over 100 parts that constitute an acceptable compliance program. The seven major "elements" are as follows:

1. Written standards are to be present and the documentation that the appropriate personnel have received a copy.
2. Designation of a compliance officer with a list of detailed duties.
3. The development and implementation of regular, effective education and training for all affected employees. This should include documentation of the training by employee.
4. There must be a demonstratively effective communication program for the employees to the compliance officer.
5. The use of audits and/or other risk evaluation techniques to monitor compliance, identify problem areas, and assist in the reduction of identified problem areas.
6. A standards enforcement program that has specified mechanisms to insure full compliance.
7. A program to detect offenses and initiate corrective action for the prevention of similar offenses.

Most of these elements seem pretty straight forward, but they are very involved and require a system of constant monitoring. For example the written policies section has 47 items listed that should be included.

There are 12 items listed under the proper management of Certificates of Medical Necessity. Included is the responsibility of the DME Supplier to monitor medical necessity and that it is properly complied with by all involved parties. The DME Supplier has to make judgements concerning medical necessity PRIOR to delivering the item(s) in question.

In addition, prior to submitting a bill to Medicare, the DME Supplier must determine that the claim is only for items that have been delivered, are covered, and are a reasonable and necessary. The DME Supplier must be certain that the appropriate HCPCS codes are shown on the claim and the proper modifiers are used.

The DME Supplier is responsible for notifying any Medicare beneficiary that an item provided will most likely not be covered by Medicare and to make sure the beneficiary understands their choices. The notification has to be documented and kept in the file. The notification must be specific and not general in the presentation.

There are many other elements included in a good compliance program. The elements listed here are only meant to provide a general feeling of the requirements for an effective compliance program. A good compliance program is an active program not just a manual. The compliance program covers all phases of the DME Supplier's operation from marketing to administrative methods.