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Choosing an automated compliance partner

By Kristi Williams bio

Sometimes the obvious isn’t so obvious.  And sometimes it takes fresh eyes to see what has been right in front of you all along.  Such is the case with automation in healthcare.

Today, healthcare organizations find themselves continuously challenged to keep up with changing regulatory requirements and to ensure that their business practices adhere to external rules and internal controls. That responsibility falls directly on the shoulders of the compliance department who is tasked with identifying risks that an organization faces and implementing controls to protect the company from those risks.

The need for an effective compliance program is not new.  It has been understood by health plans for years.  What is new, however, is that an increasing number of health plans are turning to automation to make their compliance program more efficient and effective.  And there is good reason for doing that.

An automated governance, risk and compliance (GRC) solution – three functions that are increasingly being integrated to improve enterprise performance – has shown to reduce risk and provide measurable value.  Through automation, timely notifications can be sent to users to immediately address compliance concerns when risks to the organization are identified.  Automation also increases transparency around business processes as it allows teams to easily see performance through dashboards and real-time system logic that can become an ongoing part of reporting to the Board of Directors.

Automating the compliance process has many other advantages as well.  It provides for ongoing and continuous monitoring of health plan data and operational activities.  It makes it easier to develop corrective action plans and provide a centralized location for storing all evidence of risk management, operational auditing and monitoring.  It allows for clear documentation of  identified issues and their associated remediation plans. And it allows for better tracking of ownership and task assignments for compliance with internal and regulatory time frames.

For those healthcare organizations whose compliance function hasn’t yet embraced automation, the key to doing so lies in finding a business partner who can bring both the technology and personal know-how to the process.  Here are three things to look for when seeking such a partner:

  1. Technology is most constructive when its foundation and infrastructure are based on real world action and road-tested experience. That means finding a trusted business partner whose automation products have been developed by subject matter experts who bring with them years of experience on the forefront of healthcare regulatory and compliance initiatives, operations, and business practices.  And make sure that these experts are working diligently to continuously improve processes and stay ahead of CMS requirements. In short, look for more than just “techies.”
  2. Just as some health plans have been slow to embrace analytics and the benefits it can bring, so too some compliance departments may initially hesitate turning to automation and may be wrongfully intimidated by the thought. You can overcome this by choosing a solution that is turnkey to implement and is supported by a partner who understand the impact that compliance issues can have on an organization and who are ready to provide support not only at time of implementation, but ongoing.
  3. Look for a partner whose automated solution allows a company to visualize and communicate risk at all levels of the organization. To do this, the solution should provide a centralized workflow and data management system that includes state-of-the-art compliance, analytics, monitoring, and regulatory guidance-tracking and routing capabilities. It should provide real-time auditing and monitoring of transactional data in ways that allow a health plan the opportunity to correct and address issues immediately. Only in this way can the health plan can be assured that it is keeping up with increasingly stringent regulations set forth by CMS and other regulatory bodies.

Conclusion: The right automation solution, provided by the right business partner, can save a health plan time and money while ensuring greater accountability, accuracy and efficiency.  It is a winning combination.










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