The 10 Elements of Effective Healthcare Compliance | by Healthicity

The 10 Elements of an Effective Compliance Program

1 Assessments 2 Trainings 3 Workplans 4 Policies 5 Incidents 6 Audits 7 Exclusions 8 Regulations 9 Contracts 10 Reports

1. Assessments

Risk assessments are the beginning of any effective compliance program. Create a process that identifies and documents risks to your organization. Then, be sure to regularly follow through to stay on the straight and narrow.

2. Trainings

Regular compliance training isn’t just a nice idea, it’s necessary to keep your entire organization in line. Create mandatory annual training and yearly updates to reflect regulatory changes. Bonus: Find a way to make training accessible, measurable and fun.

3. Workplans

Completing a comprehensive workplan is enormously crucial for each fiscal year. Generate an epic workplan by utilizing your risk assessment results along with updates from governing bodies. Additionally, utilize technology and resource libraries to make sure you’re nailing it.

4. Policies

Without solid guidelines, it’s almost impossible to maintain compliance. Implement required policies and procedures, including and codes of conduct, and make them accessible to everyone, all the time. And update them regularly to reflect the evolving nature of your organization.

5. Incidents

Properly documenting incidents will come in handy when the government comes knocking. Include a root cause analysis, corrective action plan, enforcement, and resolution in your incident management process. Throw out the filing cabinets and trade it in for some technology.

6. Audits

To maintain your livelihood (and compliance), you should have a defined audit plan that includes the accountability of audits and a way to track issues that are being audited. Prioritize it, plan it, implement it, then track and report your progress. Don’t be afraid to turn to outside experts when you need it.

7. Exclusions

If your organization receives reimbursement from Medicare and Medicaid, you’re required to run monthly exclusions checks. Include an analysis of both federal and state exclusion lists every month. Remember, be vigilant and monitor all employees, both new and old.

8. Regulations

Rules and regulations are constantly changing and if you’re not on top of it, it’s just a matter of time before you’re found non-compliant. Monitor changes in laws, regulations, and administrative rules. And create action plans to respond to related changes and make sure the updates are accessible to your entire team.

9. Contracts

Tracking and regularly reviewing contract terms will provide protection against an onslaught of violations. Store contracts carefully to simplify monitoring and to demonstrate compliance. Begin by introducing automation and centralizing contract locations.

10. Reports

In order to ace compliance, governing bodies and senior leaders need to be involved. Ensure that your compliance officer reports independently to governance (at least) every quarter. And provide a polished analysis of the risks you’ve identified and your efforts to solve them.