Running head PROCEDURE FOR DSME COMPLIANCE PLANS .docx

Running head: PROCEDURE FOR DSME COMPLIANCE
PLANS 1
PROCEDURE FOR DSME COMPLIANCE PLANS
8
Procedure for DSME compliance plans
Keri King
Module 5
Introduction
Diabetes self-management education (DSME) has been
clinically proven to one of the important elements that can be
used to foster recommended health care for individuals
suffering from diabetes. The reason for that is because DSME is
a continuous process meant to facilitate the skills, ability, and
knowledge required for diabetes self-care and other associated
activities that enable diabetic patients to implement and sustain
behaviors required to manage their conditions (Fitzpatrick &
Kazer, 2012). Therefore, the essence of this essay is to analyze

basic DSME monitoring tools for compliance plans.
Section A: DSME monitoring tools
a) American Association for Diabetes Education (AADA)
compliance standards checklist
The modern standard evidence for DSME assists in
indentifying the importance of providing person-centered health
care services that embraces the technological engagement
systems and platforms. All these standards are intended to the
quality of DSME as well as assist the care providers to
implement or employ evidence-based health care services to
patients successfully. This then implies that it is important to
ensure that DSME has been systematically integrated into the
modern models or health care, including population health care
programs, value-based reimbursement structures, health care
institutions, virtual visits, and so on (Fitzpatrick & Kazer,
2012).
As one of the DSME compliance tools, AADE is a multi-
disciplinary professional membership organization that is
devoted towards improving diabetes health care through
management, innovative training, and support. Its main vision
entails empowering diabetes professionals or educators to have
the potential of expanding their care dimensions. In the act of
using this tool, diabetes health care personnel will be supplied
with necessary resources that are needed to support DSME
programs. Such a program includes online application that
enables the care provider to upload his or her supporting
documents. Moreover, the diabetics education accreditation
program (DEAP) has the possibility of supporting sites in
conventional settings through expanding program options for
diabetes health care experts (Guthrie & Guthrie, 2009). This is
made possible through improving community support using
pharmacies, physicians, and so on.
On the other hand, in order to meet all these requirements
for each compliance plans, the vision and mission of AADE is
intended to position diabetes education and care professionals
for success in the modern rapidly changing environment. In so

doing, it becomes possible to elevate their duties as integrators
of DSME. Other than seeking an ongoing input from other
stakeholders, it becomes possible for the DSME providers to be
in the position of determining who to serve, the strategies to use
in delivering diabetic training, and the resources to use to offer
care support to the diabetic individuals or population (Guthrie
et al., 2002).
Nevertheless, to comply with the AADE requirements, the
program outreach to the stakeholders of the community and
their output should be documented before it is availed for
reviewing, periodically or annually. In so doing, it becomes
possible for the diabetic training and care personnel to partially
or fully integrate the pillars of its vision into their daily
practice. It is this process that ensures that all these individuals
have been positioned to work within their realms. Thus, the
opportunities provided will ultimately enable diabetes education
and care professionals to absorb new skills as well as broaden
their duties. Reexamining and redefining their level of practice
in return improves their credentialing and competencies
(Guthrie & Guthrie, 2009).
Furthermore, ideally, AADE provides diabetic education
and care professionals with streamlined and simplified
application process that enables them to meet highest health
care standards. For the new applicants, they are given a one-
year free membership. To make application easier, AADE
provides three main application sections that assist the diabetes
care providers establish their DSME services as well as prepare
for accreditation application. As a way of championing their
conversation through partnerships with legislative decision-
makers, provider and payer groups, it becomes possible to
provide patients with improved health care (Guthrie et al.,
2002). Since evidence is the foundation of modern science and
health care practices, it in return makes diabetic educators to be
an important member of the group.
b) American diabetes association (ADA) compliance standards
checklist

The aim of ADA entail educating the general public
about the dangers of diabetes as well as assisting diabetic
patients through financing research to prevent, manage, and
cure it. It should be understood that the standards recommended
for diabetes care are not projected to prohibit clinical
judgments. Because of that, its application ought to be based on
the context of exceptional medical care, with adjustments for
comorbidities, personal preferences, as well as other associated
patient factors. Nonetheless, using these standards, it updates
and improves the clinical care as well as ensures that policy-
makers, health plans, and clinicians continue to depend on them
to obtain current and authoritative procedures for diabetes
management (Kinney, 2002). The interactive applications and
tools provided by ADA acts as a guide for improving patient
care.
On the other hand, the information contained in the ADA’S
standards checklist improves the results of the diabetic
population when they are appropriately applied. Despite that, it
is evident that the evidences gathered aid in fostering accurate
medical decision-making process. Since health care
professionals ultimately care for the needs of each patient,
guidelines should be interpreted as much as possible.
Conversely, personal circumstances, for instance, education,
age, patient preferences, and values, coexisting diseases and so
on, ought to be taken into consideration because they might
result to different therapeutic strategies (Guthrie et al., 2002).
It is evident that there might be valuable evidences to support
medical trials, the significance of realizing various risk control
factors will optimize the validity of the data collected.
Seemingly, expert consensus checklist can also be
developed whenever policy-makers, regulators, and clinicians
require guidelines meant to clarify some of the modern
scientific or medical issues associated with diabetics. In return,
it makes the diabetes health care professionals to be more
committed in advocating themselves within their health care
systems. Accordingly, in the process of using ADA’s

compliance standards checklist, clear and detailed clinical
evidence from well-structured and randomized trials can be
obtained from other multicenter trials (Kinney, 2002).
The significance of these standards contained in each
checklist, will aid in reflecting modern practice and evidence
guidelines that can in return aid in evaluating outcomes. Such a
process will act as the foundation for providing diabetic self-
management education (DSME). Individual participation is also
essential in this case because it assists in determining the best
strategies to be used in managing diabetes. Ideally, the
evaluation processes to be undertaken will have the potential of
enabling the health care personnel to categorize the needs of
each patient before selecting suitable self-management
strategies, behavioral and educational interventions. Support
and education plan that will be developed by the instructor and
the participants using these standards will be ultimately based
on evidence-based techniques. It is also important to take into
account the expectations, capabilities, and barriers of the
participants. Although the primary responsibilities for the
management of diabetes and education goes to the provider of
DSME, diabetic patients benefit through obtaining support for
behavioral goals from the members of the health care team
(Guthrie et al., 2002). Finally, using these standards, it is the
duty of the provider or providers of DSME to ensure that they
have designated timeless for collecting, analyzing, and
presenting the information collected.
Section B: Procedure for compliance with AADE standards
a) Reviewing AADE policies – the applicant takes his or her
time to review AADE policies, application instructions, as well
as other standards meant for DSME and support on the AADE
website. This checklist acts as an interpretive guideline for
determining whether everything the applicant wants is contained
in it. Once AADE personnel have ascertained that the applicant
is qualified, they allow him or her to submit online application
form. After that, his or her application is review for clarity after
making payment.

b) Reviewing application details by the AADE staff – the staff
members review the applicant’s application details for
completeness and in case anything might be missing, they will
send him or her notification details. At this point, programs can
be selected randomly using on-site audit or using telephone
interviews so as to complete that process. In case of telephone
interview, the staff members of AADE will review the
application details for compliance with the AADE standards.
Moreover, in case compliance is questionable, AADE staff
might decide to plan for extra review by the top management
authority (American & Umpierrez, 2014).
c) Dissemination of application approval e-mails – once
program accreditation has been accepted or guaranteed,
approval e-mails are received by the program coordinator on a
weekly basis. After verification of the program details, a
certificate is issued to the applicant. The program will then be
included in a list of accredited diabetes self-management
education (DSME) that can be found on the AADE website.
d) Responding to pending accreditation requirements – in case
some of the accreditation requirements are not fulfilled, the
AADE staff will take their time to discuss with the applicant
about such an issue through telephone interview. In return, they
will also send a list of those elements to the program
coordinator through e-mail (Zazworsky et al., 2005).

References
Fitzpatrick, J. J., & Kazer, M. W. (2012). Encyclopedia of
nursing research. New York, NY:
Springer Pub.
Guthrie, D. W., & Guthrie, R. A. (2009). Management of
Diabetes Mellitus: A Guide to the
Pattern Approach. New York: Springer Pub. Co.
Guthrie, D. W., Guthrie, R. A., & Guthrie, D. W. (2002).
Nursing management of diabetes
mellitus: A guide to the pattern approach. New York:
Springer.
Kinney, E. D. A. (2002). Protecting American Health Care
Consumers. North Carolina: Duke
University Press.
Guthrie, D. W., Guthrie, R. A., & Guthrie, D. W. (2002).
Nursing management of diabetes
mellitus: A guide to the pattern approach. New York: Springer.
American, D. A., & Umpierrez, G. E. (2014). Therapy for
diabetes mellitus and related
disorders. American Diabetes Association
Zazworsky, D., Bolin, J., & Gaubeca, V. B. (2005). Handbook
of diabetes management. New.
York: Springer
Running head: COMPLIANCE PLANS
1
COMPLIANCE PLANS 5

Keri King
Module 4
10/27/19
Nurse charges for Diabetes Management Education as a
Physician Visit
Diabetes self-management training or education is
regarded as being one the most cost-effective means that has the
potential of improving healthcare outcomes for most patients.
Diabetes management educators are given the mandate to
provide not only training services, but also to enable their co-
workers to offer comprehensive healthcare services to patients
suffering from diabetes (Fitzpatrick & Kazer, 2012). Therefore,
what this implies is the fact that they aid in bringing a set of
unique skills to physicians, thus making them to be one of the
adjuncts of primary health care.
Ideally, diabetes educators have various tasks to
accomplish as much as health care management is concerned.
For instance, they assist diabetic patients to come up with
various skills that will enable them to manage their illness.
They also assist in improving clinical practice efficiency
through assuming various time-consuming activities such as
follow-up tasks, counseling, and patient training. Even though
they also serve as extensions of the healthcare professional
practice, they also assist in ensuring that health care provided
are up to standard. Diabetic educators, especially pharmacists,
nurses, dietitians, as well as other healthcare professionals also

dedicate their time in counseling patients on how to properly
integrate clinically proved medical behaviors or skills into their
lives (Fitzpatrick & Kazer, 2012). This then makes such an
activity to be one of the most collaborative, interactive, as well
as an ongoing procedure involving diabetic educators, diabetic
patients, and their families. The following are the main
compliance plans that ought to be followed;
1) Becoming an accredited DSMT (Diabetes self-management
training) program) – in order to be in the position of obtaining
Medicare reimbursement, it is important for nurses to ensure
that they are part of the accredited DSMT program. The same
program should also meet all the approved standards, especially
NSDSME (national standards for diabetes self-management
education) that aid in representing the guiding standards or
principles for quality DSMT.
2) Establishing friendship with other departments - because it is
vital to establish a good working relationship with other health
care team members, it is also important to take consideration
the significance of forming a cooperative relationship with
everyone. The reason for that is because it will assist in
smoothening the way for fruitful compensation for DSME
services offered. This will ultimately include finance staff,
compliance officer, billing department, and the therapeutic
record department (Gerstein & Haynes, 2001).
3) Obtaining qualified treating physician referral and
permission for patients’ appointment – in most cases, Medicare
demands referrals for DSMT health care services from the
healthcare professional who could have been managing the
beneficiary of the diabetic patient. The significance of such a
referral is that it incorporates important information needed for
the DSMT and MNT Medicare requirements.
4) Learning about diagnosis (ICD-9) and health common
procedural coding system (HCPCS) codes for compensation or
reimbursement – the reason as to why it is important to learn
about the HCPCS codes is because they contain national codes

for supplies and procedures that are not clearly defined by CPT
(current procedural codes).
5) Documenting DSMT services – in order to be in the position
of obtaining reimbursement or compensation for DSMT
services, it is important for a person to ensure that he or she has
accurately documented the services he or she had initially
provided.
6) Tracking DSMT services and compensation or
reimbursement- it is important to track DSMT services as well
as its compensation because it provides detailed information
concerning patient visits, nursing practice to diabetic patients,
the DSMT services physicians provide, and compensations for
the same services provided.
7) Marketing DSMT services as well as proactively seeking
reimbursement –DSMT is one of the fundamental parts of the
diabetic health care plans because it assists diabetic patients to
improve their therapeutic outcomes. Although some of the
diabetes health care team members might be well informed
about the importance of DSMT, it is important to remind each
other about the same periodically (American Diabetes
Association & University of Michigan, 2014).
Many employees are not able to fulfill the requirement to
discuss the facilities Mission Statement and Vision Statement
According to modern research, it is evident that the
mission and the vision statement of the company are always tied
up on the achievable goals of the workers. Once the vision and
the visions of the company have been framed in this manner, it
implies that it will be easier to integrate some of the main
organizational parts into achieving the day-to-day operating
capacities of the company. What this implies is the fact that it is
the responsibility of each worker to ensure that he or she has
executed his or her job as required into the system so as to make
it easy for the company achieves the goals of its establishment
(Chisholm et al., 2014).
In connection with that, it is evident that the mission and
the mission statements of the company is something that has

been realized to emanate from various processes that are suited
for the purpose of nurturing as well as culturing the needs of the
organization. Moreover, it is important to ensure that the
institutional budgeting priorities have been aligned with the
mission statement of the organization. The following are some
of the procedures that ought to be followed in order to achieve
the mission and the vision statement of the organization
a) Ensuring that each team member have accurately executed his
or her task as required – once the management authority has
detailed all that is required from each employee, it will be
easier to improve the output of each worker. On the other hand,
their duties will be based on the mission and vision statement of
the company from the time of their recruitment (Swansburg &
Swansburg, (2002).
b) Promoting the vision and the mission of the company through
making it visible to all stakeholders – to the management
authority, it is important to ensure that the mission and the
vision statement have been regarded as being the focal point for
development. Ideally, there is the need of ensuring that both the
mission and the mission statement of the organization remain to
be reliable and concise to each worker at each level.
c) Using story telling techniques – in order to be in the position
of improving workers’ output, it is important to use various
story telling techniques. The reason for that is because it has
been provided to have the ability to induce a positive impact to
the vision and mission statement of the organization. This
becomes an effective strategy the organization can use in
sharing the success of its workers with other team members
(Swansburg & Swansburg, 2002).
References
American Diabetes Association., & University of Michigan.
(2014). Life with diabetes: A series of teaching outlines
Michigan Diabetes Research and Training Center.
Chisholm-Burns, M. A., Vaillancourt, A. M., Shepherd, M., &
Ovid Technologies, Inc. (2014). Pharmacy management,

leadership, marketing, and finance. Burlington, MA: Jones &
Bartlett Learning.
Fitzpatrick, J. J., & Kazer, M. W. (2012). Encyclopedia of
nursing research. New York, NY: Springer Pub.
Gerstein, H. C., & Haynes, R. B. (2001). Evidence-based
diabetes care. Hamilton, Ont: BC Decker.
Swansburg, R. C., & Swansburg, R. J. (2002). Introduction to
management and leadership for nurse managers. Boston [u.a.:
Jones and Bartlett.
Swansburg, R. C., & Swansburg, R. J. (2002). Introduction to
management and leadership for nurse managers. Boston [u.a.:
Jones and Bartlett.
Running Head: COMPLIANCE PLAN 1
Comparing Compliance Plans
Keri King
Module 3
10/20/19

Procedure for diabetes management education
The first thing that nursing and hospital caregivers ought to
know is that the patients ought to be informed they ought to be
informed about the education program more so through things
office staff, or the use of signboards which are provided within
the healthcare organization. For instance, the patients ought to
be informed of CDE and RD, which are incorporated within
Diabetes Management Education (DSME), which is offered by
the instrumental health team. This form of education ought to be
provided freely, and they should be ineligible to meet the
specialist in their respective offices, which are meant for
diabetes-related training upon an order by the physician
(Wagner, 2001).
An initial physician visit ought to start with a description and
introduction on the role which is set to be performed by the
nurse. The other thing is that there is a need for the patients to
be asked on their expectation they expect to gain from the visit.
The other thing which can be conducted is an assessment of the
patient's healthcare knowledge as well as health history and
their behavior. The next step that the physician ought to do is to
evaluate the level of patient utilization of the blood glucose
meter, the appropriate injection technique, and also insulin
preparation. The physician then makes prioritization and
identified, and the diabetes management education ought to be
initiated upon the initial visit.
After such visits, the patient ought to be offered some time to

make a reflection on what they have learned, and the physician
should be in a place to ask them on a particular behavior, skill,
or goal that they need to work on. At the end of such a visit, the
patient ought to be asked about the purpose of change of their
behavior in the worksheet, which is being used in the DME
healthcare system (McCraig,2006).
Compliance Plan B: Nurse charges for Diabetes Management
Education as a Physician Visit
The following are some of the lists of policies which ought to
be adhered to which are under American Association of diabetes
educators,
The systems ought to show a structured recording when it comes
to critical issues such as medication allergies of the patient,
demographics, and the actual problem in which the patient is
suffering from diabetes condition. The records which are
indicated should be in a place to inform the care plan and also
the ongoing clinical program.
The first another compliance plan which ought to be observed I
that the care management plans which exist for diseases such as
diabetes ought to ensure that there is a timely receipt of all the
recommend ended care plans. This means that the medical
attendant should be in a place to ensure that they are being
provided with a copy of an electronic or a well-written care plan
copy. There is a need for the plan to be documented to offer
provision in the electronic medical record.
Concerning the issue of beneficiary consent, the recipient ought
to be informed that only one practitioner is in a place to furnish,
which merely for the services rendered during a calendar month.
The other thing is that patients can be identified with the use of
personal obstacles before they are being assured of the use of
another strategy. One of the plans which can be deployed is the
use of the question to collect more information. There is a need
for medical attendants to help a patient when it comes to
gaining confidence when it comes to giving essential
information on the use of insulin. There is a need for the patient

to do a practice before leaving the medical or the clinic center.
The main aim associated with this compliance program is that it
is quite essential when it comes to the implementation of fraud
detection and elimination when a healthcare organization is
transacting monetary transactions. It is drafted to address the
issue where it is observed that there exist fraudulent and
deceitful healthcare practitioners who, in most cases, try to
overcharge the patients. The other advantage of this compliance
plan is that it played a pivotal role when it comes to ensuring
that there is proper monitoring of the employees on a regular
base which is set to raise their discipline and avoid fraud
intentions.
(2) Many employees are not able to fulfill the requirement to
Mission and vision statement for an organization plays a pivotal
role when it comes to giving strategic direction, which can be
used by an organization to achieve its strategic goals in the
market. Besides the fact that most of the organization want to
realize their optimal goals in the market, there is a higher
likelihood that they do not stick to strict adherence measures in
this mission statement. In the part of the paper, we are going to
have a look at some of the actions which should be put in place
to ensure that employees get a full understanding of this
compliance plan.
This compliance is set to be taken by the human resource of the
company for it to be effective, some of the measures which
should be taken in order to ensure that employees understand
the mission and the vision of the company through a number of
ways, such moves include things such as there is need for the
human resource department to ensure that it shows total support
for all operation which is made by its most valuable human
resource which in this case are its workforce(Wagner,2001). For
instance, the organization should be in a place to ensure that it
develops an attitude of teamwork and quality in its day-to-day
operations. The Other thing is that the company can take

substantive measures which are aimed at coming up with
programs which are aimed at ensuring that there is an increase
in the company's community program support, and at the end of
the day it will be in a place to understand the company's
mission and vision statement which in most cases are aligned to
a company's undertaking. The other key thing is that there is a
need for the company to have a look at ethical conduct in terms
of personal and business practices.
As an HR compliance manager, I would be in a place to ensure
that all the employees within the organization are given the
right tools, motivation, and training to enhance their level of
performance in the market. Meeting the job requirement needs
as well as motivation are more likely to help an organization
when it comes to ensuring that employees understand both the
mission and vision statement for the company(Wagner,2001).
Another measure for the company to take under this case is to
ensure that it promotes and recruits the best individuals in the
market, the other thing is to ensure that it provides a
competitive salary and benefits package for all its employees.
This is set to ensure that it exploits the full potential of the
employees, and therefore, they can deliver following the
company's expectations.
The other thing that can ensure that employees understand the
mission as well as for the company is to ensure that the HR
department of the company is to ensure that the support the
challenges and goals which are posed by various departments
within the organization. For instance, the human resource
department should provide that the work environment for the
employees, which is characterized by fair treatment of the
employees as well as personal accountability, open form of
communication, trust as well as mutual respect. Compliance
with the mission and vision will help in avoiding conflicts of
interest as well as ensure proper adherence from the employees.
References
American Association of Diabetes Educators. (2005). Seven

self- care behaviors goal sheet.
Retrieved from
http://www.patienteducationupdate.com/2005-05-01/article7.asp
Hamilton, P.M., and Crane, L. R. (2014.) Hand hygiene.
Retrieved from
http://www.nursingceu.com/courses/467/index_nceu.html
Institute for Healthcare Improvement. (2016). The sound of two
hands washing: improving
hand hygiene. Retrieved from
http://www.ihi.org/resources/Pages/ImprovementStories/Soundo
fTwoHandsWashing.
aspx
McCraig, L. F., and Nawar, E. W. (2006) National Hospital
Ambulatory Medical Care Survey:
2004 Emergency Department Summary. Advance Data.
No.372. Retrieved from
http://www.cdc.gov/nchs/data/ad/ad372.pdf
Wagner, E.H., Austin, B.T., Davis, C., Hindmarsh, M.,
Schaefer, J., and Bonomi, A. (2001).
Improving chronic illness care: translating evidence into
action
Running head: ROLES OF A COMPLIANCE MANAGER
1
ROLES OF A COMPLIANCE MANAGER 6

Role of a Compliance manager
Keri King
10/13/2019
A compliance officer or manager is tasked with the
responsibility of ensuring that the company functions in the
right, legal and ethical manner at the same time attaining
business goals. The purpose of the two compliance plans is to
ensure there is a clear cut in qualifications for different roles or
fields. The qualification in law, finance and business
management are relevant for different fields. Compliance should
be in a written form in a simple language that could be
understood by all employees and at any time. The compliance
manager is tasked with the responsibility of reviewing company
policies, develop[p compliance program, and fully advice
management on possible risks (Moore,2005). Compliance would
benefit the company by being in the same direction as the law
requires and avoid compromise or being sued for violation and
would make auditing fast and easy while all employees would
be responsible for whatever they do. A compliance officer is
also tasked with responding to policy violations and fully
reviewing employees' work.
Job description.
· He or she would be responsible for reviewing the employees'
work.
· He or she should be the one to develop the company’s
policies. He will also be involved in responding to the
company's violation (Becker, 2012)
· Implementing and managing efficient and effective legal
compliance programs and reviewing company policies.

· He or she should be responsible for auditing the company’s
procedure.
· Others will include assessing the company's operation to
determine compliance risk and
· Getting involved in resolving clients' concerns on legal
compliance.
Qualifications
· He must be a highly qualified professional in the field.
· Must have the ability to conduct analytics.
· He must possess excellent and perfect oral and writing skills
and good communication skills.
· He must have a bachelor’s degree in law, finance, business
management or other related and recognized fields from a
recognized university or college.
· He must have experience in the field ranging from 3-5 years
(Walter, 2010).
· He must have a piece of advanced knowledge in the legal
requirements procedure.
· He must be able to assess the company's operation to
determine and ascertain compliance risks that might arise from
within or without.
Overview of compliance
A compliance plan refers to a legal and formal document
regarding a healthcare practice intention in conducting its self
following the ethical issues in business operations, care to
patients, services offered to patients and government
regulations. The motive of compliance is the provision of a
blueprint for practice and sets a baseline for employees to
report conducts that are not ethical (Snell & Troklus,2001). It is
a requirement from the federal laws for healthcare to come up
and implement a formal compliance program. The compliance
provides a guideline for the overview of compliance and due to
complexity auditing id done annually. Healthcare providers
should also seek services of law experts in the provision of
detailed guidance on the development and implementation
program.

Objective
The motive of compliance is to try to explain why compliance is
a crucial practice in health care service provision. Again the
motive is to try to detect the fraud by federal and abuse of laws.
For a long time, the department of health and human services
has been tirelessly working aiming at preventing fraud, abuse,
and waste in the health care that is funded by the federal
government. They serve to protect the integrity of the program
as well as the welfare of those likely to be beneficiaries of the
program.
Importance
A compliance plan is very important especially in the health
care [provision sector. The importance goes beyond the obvious
reasons .compliance is a requirement by the federal law and
going against it can have a severe consequence .the most
important reason for the importance is that it serves to prevent
claims that are fraudulent in nature and billing that might have
errors .compliance plan serves to prepare the auditing and
avoids the conflicting circumstances that might or are likely
to come up in business operations and also services offered to
patients should be of the best quality. If there is a violation of
a lack of compliance, the health care organization might incur
serious consequences like exclusion from Medicare or even be
forced to complete and adhere to completing corporate.
Seven fundamental elements
The compliance plan must be following the US sentencing
commission guideline manual. The guidelines are meant to
guide the health care providers in their work of service delivery
and clearly defines strategies and the plans for their compliance
programs. The seven basic fundamental elements for effective
compliance include:
· Delegating authorities via due diligence.
· Educating employees and developing effective and working
applications used in communication.
· Implementation of written policies standardizing them and

make sure they follow the procedure and the conduct.
· Clearly designating a compliance committee popularly known
as (CO) setting up a compliance committee that is tasked with
the role of oversight.
· Enforcing necessary standards via well-publicized guidelines
applied in the guidelines.
· Responding instantly and promptly in offense detection and
necessary taking correct and right action.
· Regularity conducting internal monitoring and auditing.
Implementation of the policies.
An effective and a working and working compliance program
depends and varies on the policies that are available in a
written form, in accordance with standards of conduct and the
procedures that are explained in the compliance document
(Bielgelman,2005) The compliance document explains ways to
practice commitment to the required legal standards, the
required quality of service and conducts that are in accordance
with the ethics set. It is important to note that the code of
conduct intensifies the model behavior to be adhered to by
employees and guidelines on how to report the violation and
suspected unethical violation.
References
Becker, J. M. (2012). Guide to Coding Compliance. Boston,
MA: Cengage Learning.
Biegelman, M. T. (2008). Building a World-Class Compliance
Program: Best Practices and Strategies for Success. Hoboken,
NJ: John Wiley & Sons.
Moore, M. F. (2005). ADA Compliance Manual for Employers.
Snell, R., & Troklus, D. (2001). In Search of Health Care
Compliance 2001. Burlington, MA: Jones & Bartlett Learning.

Walter, R. J. (2010). Practical Compliance with the EPA Risk
Management Program. Hoboken, NJ: John Wiley & Sons.
COMPLIANCE PLAN 4
Compliance Plan
Keri King

Regulation and Compliance in Healthcare
10/6/2019
(1) Nurse charges for Diabetes Management Education as a
Physician Visit.
Diabetes management education enables the patients who are
diabetic to manage their sicknesses. There is no standard policy
in relation to charging the patients with diabetes for the services
they receive. As a result, different nurses having been charging
different prices for its services which at times discourage the
patients who are seeking these services. To enable the
physicians to improve on the care that they give to diabetic
patients it is important to ensure that the facility has an
appropriate billing system (Buckley, 2018). This calls for
development of a compliance plan. Accuracy in billing will
increase the patient effort to get the education. A compliance
plan will help in preventing claims that are fraudulent, avoid
erroneous billing by the nurses and avoid the ethical conflicts
while providing the patient care.
(2) Many employees are not able to fulfill the requirement to
The mission and the vision statement of the company give the
facility the direction to follow and what they are expected to
achieve. Despite the fact that most of the employees want the
organizations to succeed and do things in the right way, there
are high chances that they will not strictly adhere to the
guidelines provided in the mission statements. Employees might
choose to do things according to their own knowledge and
expertise (Waugh, 2019). Even though this may lead to great
achievements there will be barriers that will stop the employees
as well as the company from moving forward. It is thus
necessary to develop a compliance plan that ensures that all the
employees know the direction to follow as well as when and
how to use the given direction. Compliance with the mission

and vision will help in avoiding conflicts of interest as well as
ensure legal adherence from the employees.
References
Buckley. (2018). Mandated Benefits 2019 Compliance Guide
(IL). Alphen aan den Rijn, Netherlands: Wolters Kluwer Law &
Business.
Buckley. (2018). Equal Employment Opportunity 2019
Compliance Guide (IL). Wolters Kluwer Law & Business.
Waugh, T. (2019). Fully Compliant: Compliance Training to
Change Behavior. American Society for Training and
Development.

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