The new healthcare interoperability rules: A risk and compliance perspective

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As payers and providers mobilize to meet the new interoperability requirements, early engagement by risk and compliance teams is critical to building a successful program and establishing control-enabled processes that create value while minimizing risk.

Keys to a successful interoperability program

An effective interoperability implementation will require a cross-functional approach to focus an organization’s efforts and resources in a concerted manner, and internal audit and compliance are critical components.

Get involved early

Collaborate with business operations and IT to develop a program strategy and roadmap to align efforts to be compliant with interoperability requirements. Be a key driver of discussions around developing control-enabled processes in a scalable and sustainable fashion.

Map risks and controls

Given the large number of new processes and capabilities, help identify risks and key controls necessary to ensure sustained compliance with interoperability requirements within IT and business operations.

Plan to audit

Conduct in-flight readiness assessment and/or add an interoperability compliance assessment / audit to your work plan for 2021. Probe into specific requirements during risk assessment discussions.

Contact us

David Curé

David Curé

Partner, Health Services Risk and Regulatory, PwC US

Kelly Tsaur

Kelly Tsaur

Principal, Health Services Payer, PwC US

Fran  Grabowski, Jr.

Fran Grabowski, Jr.

Director, Risk and Regulatory, PwC US

James Lin

James Lin

Director, Health Industries, PwC US

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