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COMPLIANCE

COMPLIANCE

Develop Customized Compliance Program

Develop Customized Compliance Program

  • Policies & Procedures: Compliance Plan, Code of Conduct, Disciplinary Policy, etc.
  • Create Customized Training & Education
  • HIPAA Privacy & Security Rules
  • Compliance Risk Assessment
  • Auditing & Monitoring
  • Policies & Procedures: Compliance Plan, Code of Conduct, Disciplinary Policy, etc.
  • Create Customized Training & Education

Medicare Advantage Specific Requirements

  • Health Plan Audits
  • Delegated Function Support: Network, Credentialing, Claims, Utilization Management
  • FDR Management
  • Health Plan Offshore Approvals
  • HIPAA Privacy & Security Rules
  • Compliance Risk Assessment
    Auditing & Monitoring

Other Essential Elements

  • Conduct Internal Audits & Investigations
  • Evaluate Appropriate Reporting Mechanisms
  • Vendor Risk Assessments

Medicare Advantage Specific Requirements

Other Essential Elements

HIPAA Privacy, Security and Breach Notifications: are you compliant once PHE waivers end?

CONTACT

Develop Customized Compliance Program

Policies & Procedures: Compliance Plan, Code of Conduct, Disciplinary Policy, etc.

Create Customized Training & Education

HIPAA Privacy & Security Rules

Compliance Risk Assessment

Auditing & Monitoring

Medicare Advantage Specific Requirements

Health Plan Audits

Delegated Function Support: Network, Credentialing, Claims, Utilization Managemen

FDR Management

Health Plan Offshore Approvals

Other Essential Elements

Conduct Internal Audits & Investigations

Evaluate Appropriate Reporting Mechanisms

Vendor Risk Assessments

CASE STUDY #1

Supported compliance initiatives for 500 employees/across 4 markets/17 global-risk/Medicare Advantage/FFS Health Plan Contracts:

• Planned, developed, implemented & managed compliance &
  privacy program

• Passed pre-delegation and annual health plan audits

• Achieved 99% completion rate for required CMS & health
  plan trainings

CASE STUDY #1

Supported compliance initiatives for 500 employees/across 4 markets/17 global-risk/Medicare Advantage/FFS Health Plan Contracts:

• Planned, developed, implemented & managed compliance & privacy program
• Passed pre-delegation and animal health plan audits
• Achieved 99% completion rate for required CMS & health plan trainings

CASE STUDY #1

Supported compliance initiatives for 500 employees/across 4 markets/17 global-risk/Medicare Advantage/FFS Health Plan Contracts:

  • Planned, developed, implemented & managed compliance &
    privacy program
  • Passed pre-delegation and annual health plan audits
  • Achieved 99% completion rate for required CMS & health plan trainings

CASE STUDY #1

Supported compliance initiatives for 500 employees/across 4 markets/17 global-risk/Medicare Advantage/FFS Health Plan Contracts:

• Planned, developed, implemented & managed compliance & privacy program

• Passed pre-delegation and annual health plan audits

• Achieved 99% completion rate for required CMS & health plan trainings

TECHNOLOGY

COMPLIANCE & OPERATIONALIZING

TECHNOLOGY
COMPLIANCE & OPERATIONALIZING

HITRUST Framework

Healthcare Applications:

HITRUST Framework

Healthcare Applications:

  • Provider
  • Patient
  • Operations Facing Applications

Data De-Identification

Off-Shore Vendor Assessments & Health Plan Approvals

Data Loss Prevention (DLP)

LMS Training System Setup

HIPAA Risk Assessment

MSA/SOW Operational Review 

  • Provider
  • Patient
  • Operations Facing Applications

Data De-Identification

Off-Shore Vendor Assessments & Health Plan Approvals

Data Loss Prevention (DLP)

LMS Training System Setup

HIPAA Risk Assessment

MSA/SOW Operational Review 

 

What digital healthcare apps, devices, etc. need to be reviewed for post-PHE impact?

CONTACT

CASE STUDY #2

Led the compliance and privacy initiatives in obtaining HITRUST certification for a hybrid Healthcare organization across multiple markets by creating policies & procedures, implementing processes and providing required training:

• Obtained HITRUST certification within 7 months

• Quickest certification seen by assessor

CASE STUDY #2

Led the compliance and privacy initiatives in obtaining HITRUST certification for a hybrid Healthcare organization across multiple markets by creating policies & procedures, implementing processes and providing required training:

• Obtained HITRUST certification within 7 months
• Quickest certification seen by assessor

CASE STUDY #2

Led the compliance and privacy initiatives in obtaining HITRUST certification for a hybrid Healthcare organization across multiple markets by creating policies & procedures, implementing processes and providing required training:

  • Obtained HITRUST certification within 7 months
  • Quickest certification seen by assessor

CASE STUDY #2

Led the compliance and privacy initiatives in obtaining HITRUST certification for a hybrid Healthcare organization across multiple markets by creating policies & procedures, implementing processes and providing required training:

• Obtained HITRUST certification within 7 months

• Quickest certification seen by assessor

OPERATIONS

OPERATIONS

Medical Group Practice Operations

Assess Operational Challenges

Staff Education & Training

Regulatory Compliance Oversight and Management

Credentialing & Contract Management

Evaluation of Organization's Functions and Work Flows

Medical Group Practice Operations

Assess Operational Challenges

Staff Education & Training

Regulatory Compliance Oversight and Management

Credentialing & Contract Management

Evaluation of Organization's Functions and Work Flows

Understanding the post-PHE regulations impact on your operations is critical going forward.

CONTACT

CASE STUDY #3

Led 300+ multi-specialty providers and 60+ clinics integrated revenue management and operational initiatives:

• Generated $2.2M net revenue gain within 12 months

• Improved operational controls reducing error rate by 50%

• Reduced clinic/provider charge lag by 50%

CASE STUDY #3

Led 300+ multi-specialty providers and 60+ clinics integrated revenue management and operational initiatives:

• Generated $2.2M net revenue gain within 12 months
• Improved operational controls reducing error rate by 50%
• Reduced clinic / provider charge lag by 50%

CASE STUDY #3

Led 300+ multi-specialty providers and 60+ clinics integrated revenue management and operational initiatives:

  • Generated $2.2M net revenue gain within 12 months
  • Improved operational controls reducing error rate by 50%
  • Reduced clinic/provider charge lag by 50%

CASE STUDY #3

Led 300+ multi-specialty providers and 60+ clinics integrated revenue management and operational initiatives:

• Generated $2.2M net revenue gain within 12 months

• Improved operational controls reducing error rate by 50%

• Reduced clinic / provider charge lag by 50%

REVENUE CYCLE

REVENUE CYCLE

 Healthcare Revenue Cycle Management

AR Analysis

Payer Contract Review

Coding, Billing & Regulatory Review

Operational Auditing & Monitoring

Operationalizing Value-Based Reimbursement

AR Analysis

Payer Contract Review

Coding, Billing & Regulatory Review

Operational Auditing & Monitoring

Operationalizing Value-Based Reimbursement

How will finance and revenue cycle be impacted once the public health emergency ends?

CONTACT

CASE STUDY #4

Implemented LEAN processes enhancing value to patient and reducing inefficiencies:

• Reduced A/R by 51% and days in A/R by 58%

• Reduced charge lag from 58 days to 15 days

• Drove $2M + increased revenue implementing coding
  department processes

CASE STUDY #4

Implemented LEAN processes enhancing value to patient and reducing inefficiencies:

• Reduced A/R by 50% and days in A/R by 58%
• Reduced charge lag from 58 days to 15 days
• Drove $2M + increased revenue implementing coding department processes

CASE STUDY #4

Implemented LEAN processes enhancing value to patient and reducing inefficiencies:

  • Reduced A/R by 51% and days in A/R by 58%
  • Reduced charge lag from 58 days to 15 days
  • Drove $2M + increased revenue implementing coding department processes

CASE STUDY #4

Implemented LEAN processes enhancing value to patient and reducing inefficiencies:

• Reduced A/R by 50% and days in A/R by 58%

• Reduced charge lag from 58 days to 15 days

• Drove $2M + increased revenue implementing coding department processes

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Contact

Mailing Address
PO Box #778375
Henderson, NV 89077

Email Address
Sheryn@TheHonestApproach.com

Phone Number
(702) 561-8549

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