Provider services and solutions

Risk and compliance management: Corporate risk compliance and management

The challenge

Healthcare providers are experiencing unprecedented change. Much of the change is related to federal, state and local regulatory changes surrounding healthcare reform. In addition, continued emphasis on quality and evidence based care is prompting regulatory involvement that negatively impacts reimbursement and margin. New challenges are certain to emerge through the adoption of health-information technology, ICD-10 and reforms related to Medicare and Medicaid. Providers need to ensure that effective compliance practices are integrated into their everyday business processes.

Providers must develop standards, processes and internal controls to identify and mitigate risk, designed not only to ensure regulatory compliance, but to improve operational effectiveness, increase quality and obtain appropriate reimbursement.

How we can help you

• Adopting an enterprise-wide view of risk and compliance management can be both challenging and rewarding.
  • We can help you better identify the risks in your business strategy and improve the alignment of people, processes and technology in a manner to reduce enterprise wide risks.
• Your compliance programs should identify and monitor risks and plan proactive responses to incidents of noncompliance and fraud.
  • We can help you develop compliance programs that meet the federal requirements and address the people, process and technology issues surrounding regulatory requirements. We can help you identify the cost of compliance and develop a more integrated, cost effective and value added approach to regulatory compliance across the enterprise.

Common services include

• Enterprise-wide risk assessments
• Developing annual compliance auditing plans
• Evaluating documentation, coding and billing processes
• Privacy and Security risk assessments
• Recovery Audit Contractor (RAC) preparedness and risk management
• ICD 10 impact analyses