How to Measure Effectiveness of Your Healthcare Compliance Program - PowerPoint PPT Presentation

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How to Measure Effectiveness of Your Healthcare Compliance Program

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This question stated above is probably more applicable to all healthcare compliance programs, suggests the healthcare lawyer Las Vegas, regardless of subsections of the health care industry, or other industries too, in fact. – PowerPoint PPT presentation

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Title: How to Measure Effectiveness of Your Healthcare Compliance Program


1
How to Measure Effectiveness of Your Healthcare
Compliance Program
2
  • While it is absolutely crucial to have an
    effective healthcare compliance program at place,
    it is also important to measure the success of
    that compliance program, which could be
    difficult.
  • The available measures-of-success arent always
    industry-specific.
  • However, when there is no specific publication in
    place for your needs, you might be able to rather
    adapt some of the tools and resources mentioned
    here, in order to assess whether your healthcare
    compliance program is effective or not

3
Self-Assessment Questionnaire
  • You can use a self-assessment questionnaire for
    prescription drug and Medicare Advantage
    healthcare compliance program effectiveness.
  • In this questionnaire, you would find twenty-six
    pages of questions that specifically relate to
    various elements of effective healthcare
    compliance programs.

4
  • For instance, Element II (Governing Body,
    Compliance Committee, Compliance Officer), it
    asks Does the compliance officer at your
    organization has express authority (written or
    oral, preferably in written form) to make the
    in-person reports to the CEO and the Board of
    Directors in the sole discretion of the
    compliance officer?
  • This question stated above is probably more
    applicable to all healthcare compliance programs,
    suggests the healthcare lawyer Las Vegas,
    regardless of subsections of the health care
    industry, or other industries too, in fact.

5
OIG Supplemental Healthcare Compliance Program
Guidance for Medical Centres and Hospitals
  • Most healthcare compliance officers are already
    familiar with various OIG healthcare Compliance
    Program Guidance or CPG documents for the
    different segments of health care industry.
  • A complete list could be easily found on the
    official website of OIG. A recent CPG includes
    Supplemental Healthcare Compliance Program for
    the Hospitals.
  • CPGs Section III mentions Compliance Program
    Effectiveness for Hospitals.

6
  • This section follows an approach that is similar
    to that of Medicare Advantage Questionnaire,
    where Medicaid investigations are also mentioned.
  • Various questions are included as these questions
    relate to the 7 components of effective
    compliance programs.
  • You would find a frequency for these assessments
    as well, for instance Hospitals need to
    regularly review implementation execution of
    the elements of their healthcare compliance
    program.

7
  • Such a review needs to be conducted atleast once
    a year and include a thorough assessment of each
    and every basic elements of the program
    individually, along with the overall success of
    the compliance program.
  • While some questions may be specific to
    hospitals, it could be easily adapted to other
    types of organizations and providers.

8
  • Self-Assessment Form for Compliance Program from
    the NYC Office of Medicaid Inspector-General
  • The New York (NY) Law requires the specific
    Medicaid provider(s) to certify their healthcare
    compliance program every year. In order to aid
    the provider in making sure that their healthcare
    compliance program is meeting requirements, a
    self-assessment form is thereby provided. This
    form asks several questions that relates to
    various elements of the compliance program under
    the New York Law. It requires 8 elements of the
    compliance program. Here, the 8th element calls
    specifically for policy of non-retaliation and
    non-intimidation.
  • All in all, though there may not be a
    popularly-accepted solution to score compliance
    program effectiveness yet, there surely are
    certain tools to give compliance professionals a
    good enough starting point.

9
Thank You
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