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?
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
- 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?
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.
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?
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
