Compliance 360

Compliance 360 Integrates New York State Office of Medicaid Inspector General’s Compliance Program Assessment Tool

2011-07-13T13:11:00.001-07:00

Automated Assessments Provide Healthcare Organizations with a Continually Audit-Ready State

ATLANTA – July 11, 2011 – Compliance 360, a leading provider of Software-as-a-Service (SaaS) solutions for enterprise governance, risk management and compliance (eGRC), today announced that it has automated the Compliance Program Assessment Tool, published by the New York State Office of Medicaid Inspector General (NY OMIG), in the Compliance 360 system. This enhanced capability, which is available now and free of charge for all Compliance 360 customers, will allow healthcare organizations to maintain a continually audit-ready state in an era of increased regulatory scrutiny. Compliance 360 will host an online demonstration of this new functionality on Thursday, July 14, at 2:00 p.m. EDT.

The Patient Protection and Affordable Care Act mandates that healthcare organizations implement compliance plans. Regulators, including NY OMIG, are raising the stakes by proactively publishing compliance effectiveness assessment tools. Based on its unique publish-subscribe capabilities, the Compliance 360 system is ideally suited for automating these tools. Healthcare organizations can streamline processes, minimize overhead and ensure that nothing is overlooked as they maintain a continually audit-ready state. Regulators benefit from well-organized data that is accurate, current and easily accessed online.

The NY OMIG Compliance Program Assessment Tool is structured into eight sections, which include a series of assessment questions with “Yes” and “No” answers, with provisions for identifying supporting evidence and compliance gaps.

Compliance 360’s automation of this tool includes all of the assessment questions in each of the eight categories. For each question, the assessment will result in a task created based on “Yes” and “No” answers. A “Yes” answer will result in a task created for linking evidence documents back to the requirement using the Virtual Evidence Room™. A “No” answer will result in a task created to identify the compliance gap(s) and initiate remediation actions. Online dashboards and reports show the overall compliance status with all supporting documents, completed and open tasks, task owners, due dates and more. Compliance officers can view the overall compliance status at any time and receive alerts regarding critical tasks that are overdue.

“As healthcare compliance professionals increasingly face demands to proactively demonstrate the effectiveness of their compliance programs, automation such as this will help them ease the potential burdens and prove that their compliance programs are working,” said Steve McGraw, president and CEO, Compliance 360. “NY OMIG has set the de facto standard for healthcare by publishing the industry’s first definitive compliance assessment tool for its constituents. Going forward, we expect to see similar assessment tools published for other regulated industries, and we plan to provide similar integrations for our customers as these tools are published.”

Compliance 360 will host an online demonstration of the NY OMIG Compliance Program Assessment Tool automated in the Compliance 360 system on Thursday, July 14, at 2:00 p.m. EDT. Healthcare providers and health plans can register to attend the demo at www.compliance360.com/NYOMIGdemo.

About Compliance 360
Ranked as the fastest growing GRC software vendor in Inc. Magazine’s 2010 list of America’s fastest growing private companies , Compliance 360 is the leading provider of enterprise governance, risk management , compliance and audit management solutions for companies that operate in regulated industries. With these solutions, organizations reduce risks, improve efficiencies and protect their brands using a single platform to address their comprehensive GRC requirements. The Compliance 360 Software-as-a-Service (SaaS) solution suite helps organizations address policy and procedure management, regulatory compliance management , internal and external audits , third party risk and vendor management , contract management, incident management, fraud, waste & abuse , surveys, accreditation, enterprise risk management and IT governance. Compliance 360 is headquartered in Atlanta and assists more than 225,000 users every day in a variety of complex, regulated business environments, including healthcare, insurance, financial services and others. For more information, visit www.compliance360.com .

Disclaimer: The New York Office of the Medicaid Inspector General (OMIG) permits Compliance 360 to use OMIG’s
Provider Self-Assessment Tool – 2010 within the Compliance 360 system. OMIG’s permission is not an endorsement
of the Compliance 360 system.

Editor’s Note: Compliance 360 is a registered trademark of Compliance 360, Inc. Virtual Evidence Room is a registered service mark of Compliance 360, Inc. Any other trademarks are recognized as proprietary to their owners.

Media Contact
Ashleigh Egan
Articulate Communications, Inc.
Tel: (212) 255-0080, ext. 12
compliance360@articulatecomms.com

Compliance 360 Announces Next-Generation Reporting System

2011-02-24T07:46:00.000-08:00

Step-by-Step, Wizard-Driven Application Combines End-User Ease and Flexibility with Low Implementation and Maintenance Overhead

ATLANTA – Feb. 22, 2011 – Compliance 360, a leading provider of Software-as-a-Service (SaaS) solutions for enterprise governance, risk management and compliance (eGRC), today announced the availability of its next-generation reporting system. The new system combines the wizard-driven flexibility of full report customization with the ease, efficiency and low overhead of an online-hosted solution.

In response to the increasing demand for more flexible reporting options and the desire of end users to manage and customize reports without dependence on IT resources, the latest version of the Compliance 360 reporting system provides a range of reporting options to address the needs of both non-technical and advanced users.

The application provides pre-configured report options and templates, and an easy-to-use wizard that guides users through the creation, customization and execution of reports with a simple step-by-step approach. All data stored within the Compliance 360 suite of GRC applications is available for live, up-to-the minute reporting based on users’ security permissions. There is no need to incur the overhead of separate, mirrored data stores for reporting.

“To meet the needs of organizations today and in the future, GRC software platforms must be adaptable and agile,” said Steve McGraw, president and CEO, Compliance 360. “The Compliance 360 system is evolving rapidly and now provides the advanced reporting tools that business users need to define, execute and report on critical GRC information free of dependence on IT. Our objective is to provide customers with the freedom of choice to use the method of reporting that best fits their needs; whether it is standard, off-the-shelf reports, reports produced by our advanced SaaS-based reporting system or exporting information to a data warehouse for advanced analytics.”

Features of the new reporting system include:

* Easy-to-use report wizard that guides users through the creation and execution of reports, including variable sorting and grouping, field selection, calculations, filters and report selection criteria. Dynamic report previews are updated as selections are made by the user.
* Advanced filtering capabilities that support nesting of criteria and multiple operators such as “AND”, “OR” and “NOT” to precisely retrieve relevant data.
* Guided setup and configurable reporting options provide the ability to schedule reports to run on a one-time or recurring basis with automated e-mail notifications to users.

“The release of the next-generation reporting system expands our capabilities to provide advanced reporting options that our customers need,” said Bob McGowan, vice president of product management, Compliance 360. “They now have the versatility to define reports that include exactly the data they need through a flexible reporting system integrated into the SaaS GRC solution, without the high cost and overhead usually associated with on-premise applications.”

The new reporting system is generally available now for all Compliance 360 customers.

About Compliance 360
Ranked as the fastest growing GRC software vendor in Inc. Magazine’s 2010 list of America’s fastest growing private companies , Compliance 360 is the leading provider of enterprise governance, risk management , compliance and audit management solutions for companies that operate in regulated industries. With these solutions, organizations reduce risks, improve efficiencies and protect their brands using a single platform to address their comprehensive GRC requirements. The Compliance 360 Software-as-a-Service (SaaS) solution suite helps organizations address policies and procedures management, regulatory compliance management , internal and external audits , third party risk and vendor management , contract management, incident management, fraud, waste & abuse , surveys, accreditation, enterprise risk management and IT governance. Compliance 360 is headquartered in Atlanta and assists more than 225,000 users every day in a variety of complex, regulated business environments, including healthcare, insurance, financial services and others. For more information, visit www.compliance360.com .

Editor’s Note: Compliance 360 is a registered trademark of Compliance 360, Inc. Virtual Evidence Room is a registered service mark of Compliance 360, Inc. Any other trademarks are recognized as proprietary to their owners.

Media Contact
Ashleigh Egan
Articulate Communications, Inc.
Tel: (212) 255-0080, ext. 12
compliance360@articulatecomms.com

Compliance 360 Extends “Cash-for-Clunkers” Trade-In Program

2010-11-30T07:05:00.000-08:00

Program Extended Due to Popularity with Healthcare Providers and CMS Initiatives to Expand RAC Audit and Revenue Recovery Programs for Medicare and Medicaid in 2011

Atlanta, GA. – November 30, 2010 – Compliance 360, a leading provider of Software-as-a-Service (SaaS) solutions for enterprise governance, risk management and compliance (eGRC) today announced that its popular “Cash-for-Clunkers” trade-in program for healthcare providers has been extended until May 31, 2011. The program provides discounts to healthcare providers that initially invested in low-end, limited-functionality software applications for managing overpayment recovery audits including Medicare and Medicaid Recovery Audit Contractor (RAC) Audits and Medicaid Integrity Contractor (MIC) audits.

Congress and the President expect the recovery of Medicare and Medicaid overpayments to fund many of the new healthcare programs. The goal is a reduction in improper payments of at least 50% by 2012. In support of these lofty goals, provider reimbursements will come under increasing scrutiny as the current recovery audit programs expand in 2011 to include:
• RAC for Medicaid, in addition to the current Medicaid Integrity Contractor (MIC) audit program
• RAC program expansion to include Medicare parts C and D

“As the anticipated risks of RAC and MIC audits became a reality in 2009 and 2010, many healthcare providers made hasty software selections and are now learning that their software, with limited flexibility, is providing only minimal revenue protection,” said John Brooke, General Manager of Healthcare for Compliance 360. “As the revenue recovery audits increase in 2011, these limitations are likely to become even more pronounced.”

The Compliance 360 Claims Auditor, licensed for use in over 900 healthcare facilities nationwide, is proven to help healthcare providers take control of medical claims audits and appeals, and protect their legitimate revenues from being caught up in the recoupment of overpayments. With advanced workflow, healthcare providers can manage the complexity of multiple, simultaneous recovery audits to ensure that due dates are not missed. Serving as the “Virtual Audit Coordinator”, the Claims Auditor automatically manages each step in the response and appeals process, allowing key personnel to concentrate on high-risk areas and monitor the overall program. The Claims Auditor also serves as the claims audit system of record, enabling healthcare providers to establish a common point of control for managing all claims audits including RAC, MIC, MAC, CERT, PERM, ZPIC and commercial payor audits.

“In response to the expanded audit programs planned for 2011 as well as requests from providers across the country, we are happy to extend our Cash for Clunkers program,” added Brooke. “Under the proposed regulations for expanded audits, States may use their current administrative appeals process or may modify the process for Medicaid RAC appeals. Adapting to these yet-to-be–published appeals processes, that will vary from state-to-state, will create a new set of challenges for providers and especially for those using software solutions with limited flexibility. Fortunately with Compliance 360, providers can easily adjust as appeals processes are changed by simply tuning the workflow to match the process.”

Healthcare providers interested in taking advantage of the “Cash-for-Clunkers” trade-in program, should contact Compliance 360 at sales@compliance360.com or (678)992-0262. The program is currently scheduled to run through May 31, 2011.

About Compliance 360 for Healthcare
Compliance 360 is the leading provider of enterprise governance, risk management, compliance and audit management solutions for healthcare providers. With these solutions, healthcare providers reduce risks, improve efficiencies and protect their brands using a single platform to address their comprehensive GRC requirements. The Compliance 360 solution for healthcare addresses the need for policy management, centralized regulatory management including HITECH, HIPAA, EMTALA, STARK and others, Joint Commission Accreditation, OIG corporate integrity agreements (CIA), False Claims Act (FCA) Compliance, adverse-event management, contract management, surveys, remediation projects, claims audits and denials, Medicare RAC audits, Medicaid MIC Audits, self assessments, internal audits, and enterprise risk management. Over 150,000 active users rely on Compliance 360 everyday to manage their risk, audit and compliance programs. To learn more about the Compliance 360 solution for healthcare, visit www.compliance360.com/healthcare.

Editor’s Note: Compliance 360 is a registered trademark of Compliance 360, Inc. Virtual Evidence Room is a registered service mark of Compliance 360, Inc. Any other trademarks are recognized as proprietary to their owners.

Why is Third Party Risk Managment Important To You?

2010-10-15T09:53:00.000-07:00

www.compliance360.com/thirdpartyrisk

Webcast - Managing Delegated Entities: Ensuring Compliance and Mitigating Risk

2010-09-07T13:23:00.000-07:00

Click here for registration link

Compliance and risk management are growing in importance as managed care organizations increasingly turn to delegated entities to reduce operating costs and streamline operations. Amid the benefits of outsourcing, there lies a significant risk. Simply stated, responsibility and liability cannot be outsourced.

Managed care organizations now face increasing pressure from their regulators, to demonstrate that they are proactively taking steps to mitigate risks by ensuring compliance among their delegated entities.

Join us for this presentation with Tom Goddard and Ellen Pauley of Integral Healthcare Solutions, LLC, in which they will outline best practices for managing and minimizing third party risks with delegated entities. The presentation will focus on:

Comparison of the definitions of Delegation used by NCQA and URAC
Recommended areas of focus in due-diligence before engaging with a delegated entity
Recommendations for crafting agreements with delegated entities
Best practices and common deficiencies in the oversight of delegated entities
Discussion of the future of managing delegated entities including trends in outsourcing, trends in regulation and accreditation, and trends in technology

CFO and CEOs
Chief Risk Officer
Chief Compliance Officer
Chief Security Officer
Legal/Regulatory Counsel

About the Presenters:

The CEO of Integral Healthcare Solutions, LLC, Thomas G. Goddard, JD, PhD, is one of the industry’s premier URAC analysts. He served as Chief Operating Officer and General Counsel of URAC, and since leaving that organization has over seen a firm that has specialized for 9 years in working with applicants for URAC accreditation.

Ellen Pauley, RN, MS, served as Assistant Director of Accreditation Operations/ Surveyor at NCQA's office in Washington, DC. Over the last 18 years, she has served both as an NCQA review and as one of the nation’s premier consultants to organizations seeking NCQA accreditation.

Compliance 360 Addresses Healthcare Reform Challenges for Customers

2010-07-14T07:01:00.000-07:00

Steve McGraw, President and CEO,
Compliance 360

The healthcare reform bill passed into law as the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010 creates many new and pending regulatory challenges for healthcare providers and health insurance organizations. At Compliance 360, we have analyzed the legislation section by section and have identified the key areas where Compliance 360 can greatly assist an organization in managing this prodigious federal legislation. The end result of this analysis is a series of whitepapers outlining best practices for PPACA compliance and audit Requirements. In the coming months as the new healthcare mandates are rolled out, Compliance 360 will publish a series of papers outlining the solution’s capabilities and benefits related to the key regulations and audit requirements. To request the first paper in the PPACA compliance framework series, please visit www.compliance360.com/HealthcareReform.

Seven Elements of an Effective Compliance & Ethics Program

2010-06-25T07:29:00.000-07:00

Steve McGraw, President and CEO, Compliance 360

Recently, the United States Sentencing Commission voted to modify the Federal Sentencing Guidelines, including the standards for an effective corporate compliance and ethics program. Under the Federal Sentencing Guidelines, a convicted organization may be eligible for a reduced sentence if it has established an effective compliance and ethics program. The Guidelines describe the key attributes that a compliance program must exhibit for the organization to be eligible to receive benefits such as reduced fines, reduced sentences or deferred prosecution.

Forward thinking organizations seeking to develop and foster an effective compliance and ethics program are turning to Governance, Risk Management and Compliance (GRC) software applications to help facilitate this endeavor. We invite you to download the white paper, "The Seven Elements of an Effective Compliance and Ethics Program" to learn more about the seven elements of an effective compliance and ethics program and the key capabilities that a GRC software solution should have in order to serve as the foundation for an effective compliance and ethics program.

Compliance 360 Launches “Cash-for-Clunkers” Trade-In Program

2010-06-23T06:30:00.000-07:00

Healthcare Providers Can Receive Trade-In Credit When Licensing the Compliance 360 Claims Auditor for Managing Medicare and Medicaid Overpayment Recovery Audits

Atlanta, GA. – June 21, 2010 – Compliance 360, a leading provider of Software-as-a-Service (SaaS) solutions for enterprise governance, risk management and compliance (eGRC) today announced a “Cash-for-Clunkers” trade-in program for healthcare providers that initially invested in low-end, limited-functionality software applications for managing overpayment recovery audits including Medicare Recovery Audit Contractor (RAC) Audits and Medicaid Integrity Contractor (MIC) audits.

The Compliance 360 Claims Auditor, licensed for use in over 800 healthcare facilities nationwide, helps healthcare providers take control of medical claims audits and appeals, and protect their legitimate revenues from being caught up in the recoupment of overpayments. With a sophisticated workflow engine, healthcare providers can manage the complexity of multiple, simultaneous recovery audits to ensure that due dates are not missed. Serving as the “Virtual Audit Coordinator”, the Claims Auditor automatically manages each step in the response and appeals process, allowing key personnel to concentrate on high-risk areas and monitor the overall program. The Claims Auditor also serves as the claims audit system of record, enabling healthcare providers to establish a common point of control for managing all claims audits including RAC, MIC, MAC, CERT, PERM, ZPIC and commercial payor audits.

“As RAC audits have transitioned from a limited demonstration status to a full nationwide rollout over the last 18 months and MIC audits have also been ramping up, many hospitals have taken a conservative approach, investing in software solutions with very limited functionality, providing only minimal revenue protection. Given the government’s track record of recurring postponements of new regulatory programs, this approach is quite understandable,” said John Brooke, General Manager of Healthcare for Compliance 360. “However, now that the Medicare and Medicaid revenue recovery programs are rolling out and even accelerating as a result of the highly publicized focus on cost savings and anti-fraud initiatives in the new healthcare reform law, healthcare providers are seeking robust, replacement solutions, proven to protect their legitimate revenues from being recouped. For those providers that are now discovering their initial choice of a limited solution is not providing adequate revenue protection, we are offering discounts in the form of trade-in credits when they upgrade to the Compliance 360 Claims Auditor. Based on the increased activity we’ve seen since the passage of healthcare reform, we expect this program to be very popular with healthcare providers.”

The Compliance 360 Claims auditor will be featured at the HFMA 2010 ANI Healthcare Conference in Las Vegas, June 20-23. Healthcare providers interested in taking advantage of the “Cash-for-Clunkers” trade-in program, should contact Compliance 360 at sales@compliance360.com or (678)992-0262. The program is currently scheduled to run through November 30, 2010.

About Compliance 360

Compliance 360 is the leading provider of enterprise governance, risk management, compliance audit management solutions for healthcare. With these solutions, healthcare providers and insurance companies reduce risks, improve efficiencies and protect their brands using a single platform to address their comprehensive GRC requirements. The Compliance 360 solution for healthcare addresses the need for policy management, centralized regulatory management HITECH, HIPAA, EMTALA, STARK and others, Joint Commission Accreditation, OIG corporate integrity agreements (CIA), False Claims Act (FCA) Compliance, adverse-event management, contract management, surveys, remediation projects, claims audits and denials, Medicare RAC audits, Medicaid MIC Audits, self assessments, internal audits, and enterprise risk management. Over 150,000 active users rely on Compliance 360 everyday to manage their risk, audit and compliance programs. To learn more about the Compliance 360 solution for healthcare, visit www.compliance360.com. and including

Editor's Note: Compliance 360 is a registered trademark of Compliance 360, Inc. Virtual Evidence Room is a registered service mark of Compliance 360, Inc. All other trademarks are recognized as proprietary to their owners.

Media Contact
Compliance 360, Inc.
Scot McLeod
VP, Marketing
(678) 992-0262
media@compliance360.com

Webcast: HIPAA/HITECH Consumer Sentiment Benchmark Results

2010-05-17T11:59:00.000-07:00

Click HERE to register.

During our January 13th Webcast, Dr. Larry Ponemon, chairman and founder, Ponemon Institute, and Raj Chaudhary, principal with Crowe Horwath LLP, provided a firsthand look at the findings from the recently released benchmark study: “Are You Ready for HIPAA/HITECH? A Benchmark of Healthcare Companies.”

In this session, Dr. Larry Ponemon and Raj Chaudhary will provide answers to these additional common questions:

How frequently are healthcare organizations testing and updating their HIPAA/HITECH compliance programs?
How prevalent are deficiencies in HIPAA/HITECH compliance programs?
Which HIPAA/HITECH compliance requirements are most fully implemented?
Which HIPAA/HITECH compliance requirements are impacting business operations?
Which HIPAA/HITECH compliance requirements are necessitating 3rd-party assistance?
What is the average cost of HIPAA/HITECH compliance based on organization size?

Key findings and analysis from the HIPAA/HITECH & Consumer Sentiment Benchmark will also be discussed, including:

94% of the respondents are not ready to comply with the privacy and security provisions of the HITECH Act
90% of respondents had a breach involving at least one protected health record
55% of respondents report there is no management support for HITECH compliance
60% say their organizations have only partially implemented a risk-based program for protecting the privacy of PHI
More than 73% of consumers that responded do not trust the Federal Government including HHS, to protect the privacy of their health records
Consumers that responded view health records as the most privacy sensitive of all private information (above bank account, income taxes, and credit card information)

The session will include next-step suggestions for HIPAA/HITECH compliance and preparing for inspections by the Office for Civil Rights. A live question and answer session with the presenters will be included and webinar attendees will receive access to complimentary copies of the benchmark study and the Crowe Horwath whitepaper “Raising Healthcare Security and Privacy Standards: Complying With HIPAA and the HITECH Act”.

Who Should Attend:

Healthcare Providers, Payors and Business Associates
Privacy Officer or Director
Chief Compliance Officer or Director
HIM Officer or Director
Security Officer or Director
CFO, CEO
Chief Risk Officer or Director
Legal/Regulatory Counsel

About the presenters:

Dr. Larry Ponemon is the Chairman and Founder of the Ponemon Institute, a research “think tank” dedicated to advancing privacy and data protection practices. Dr. Ponemon is considered a pioneer in privacy auditing and the Responsible Information Management or RIM framework. Dr. Ponemon consults with leading multinational organizations on global privacy management programs. He has extensive knowledge of regulatory frameworks for managing privacy and data security including financial services, health care, pharmaceutical, telecom and Internet. Dr. Ponemon was appointed to the Advisory Committee for Online Access & Security for the United States Federal Trade Commission. He was also appointed by the White House to the Data Privacy and Integrity Advisory Committee for the Department of Homeland Security.

Raj Chaudhary is a Principal and National Practice Leader for the Security and Privacy Practice of Crowe Horwath LLP. Raj is an industry thought leader in the area of privacy and data protection. He consults with major entities in the private and public sector in assisting them with remediation of deficiencies in safeguarding information. He has extensive knowledge of regulatory frameworks for managing security and privacy in multiple industries including financial services, health care and public sector.

Webcast: Strengthening Oversight for Improved Governance and Strategic Benefit

2010-04-26T11:11:00.000-07:00

As a result of current economic conditions and market demands for increased transparency, enterprise risk management is rapidly becoming the focal point for initiatives to improve corporate governance. Yet according to a recent survey of enterprise risk management practices, 75% of organizations still do not report key risk exposures to their boards of directors. These organizations are increasingly at risk of regulatory sanctions and preventable yet unforeseen emerging risks to their brands and core strategic initiatives.

Join us for this session with Mark Beasley, in which he’ll share insights from recent research conducted with over 300 CFO’s about the current state of enterprise risk oversight. The research uncovered broad dissatisfaction among executives with their organization’s risk management practices and results. In addition to the survey results, this session will address:

What are the limitations with today’s common risk management approaches?
What are progressive organizations doing in response to increased expectations for more robust risk oversight at the board and senior executive levels?
Why is better risk intelligence, especially related to emerging risks, critical to long-term strategies?
What steps can senior executives take to strengthen their focus on oversight of the organization’s top emerging risk exposures?

Who Should Attend:

Board of Directors and Audit Committee Members
CEO, CFO
Chief Risk Officer
Chief Compliance Officer
Chief Security Officer
General Counsel
General Audit Executive
Chief Strategy Executive

Reference Materials:

Webinar attendees should download and review these COSO documents prior to the live session:

Click HERE to download ERM Document 1
Click HERE to download ERM Document 2

Attendees of the live session will also receive a copy of the survey report on the current state of risk management practices.

About the Presenter:

Mark Beasley is the Deloitte Professor of Enterprise Risk Management at the College of Management at North Carolina State University in Raleigh, North Carolina. The Enterprise Risk Management (ERM) Initiative at NC State provides thought leadership about ERM practices and their integration with strategy and corporate governance. As founding director, Dr. Beasley leads the ERM Initiative's efforts to help pioneer the development of this emergent discipline through outreach to business professionals, with its ongoing ERM Roundtable Series and ERM Executive Education for boards and senior executives; research, advancing knowledge and understanding of ERM issues; and undergraduate and graduate business education for the next generation of business executives (www.erm.ncsu.edu). He frequently works with boards of directors and senior management teams to assist them in strengthening their risk oversight processes.

RAC Audits: Managing Risks Shared Between Hospitals & Physicians Practices

2010-03-30T09:37:00.000-07:00

The RAC Auditors are now rolling at full steam; targeted DRGs are approved and posted, and medical necessity audits are on the way. Many providers have established a RAC team or at least designated a RAC coordinator. Those seeking to get ahead and maintain control of RAC audits have updated their policies and procedures and set up a system for managing the RAC audit and appeals process. Providers are using these systems to ensure that everyone is held accountable for timely contributions throughout the audit and appeals process and to ultimately reduce the risk of lost revenue.

In spite of all the preparation for responding to RAC audits, many provider organizations have not adequately examined their root causes for RAC audit vulnerabilities. The established policies of many hospitals are creating unnecessary RAC audit risks for individual physicians and physician groups. In turn, the common practices of many physicians are creating unnecessary RAC audit risks for their hospitals.

Join us for this educational webinar that will explore these RAC audit risks shared between the hospitals and physicians and offer practical recommendations for minimizing vulnerabilities. Case study examples from recent RAC audits will be used to illustrate the findings and recommendations.

Who Should Attend

Hospitals
Physicians and their staffs
CFO, CEO
Chief Compliance Officer
Compliance Director
Chief Risk Officer
Director of Risk Management
Director of Regulatory Affairs
Hospital Legal/Regulatory Counsel
VP/Director of Revenue Cycle

About the Presenter

Day Egusquiza brings over 28 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. Additionally, her experience includes eight years as a Director of a Physician Medical Management billing service and most recently completed an integrated business office between a hospital and a large physician clinic. She has been an entrepreneur in hospital and physician practice accounts receivable management and a leader in redesigning numerous organizations. Her work includes providing guidance as a compliance and APC educator while providing operational insight on the revenue cycle impacts of HIPAA. Additionally, she has been instrumental in researching and preparing national education on the impact of the Prescription Drug Benefit to hospitals and nursing homes. Ms. Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance- both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, HFMA faculty, CCH Reimbursement Advisory board and is a past President of the Idaho HFMA Chapter &; recently received the Lifetime Achievement Award. She has been highlighted in JCAHO's Six Hospitals in Search of Excellence, Zimmerman's Receivable Report, HFMA's HFM and Patient Account, AHIA Prospective, and numerous healthcare newsletters along with a contributing author to 2006 Health Law and Compliance Update. She received the Idaho Hospital Association Distinguished Service Award; for her legislative work and training on new indigent law. Attendees at HFMA's ANI rated her in the top 25%, earning her the 'Distinguished' Speaker recognition for each year she has presented.

www.compliance360.com

Webcast: Managing Medicaid MIC Audits and Appeals - An Operational Guide featuring Sara Kay Wheeler of King & Spalding

2010-03-18T09:19:00.000-07:00

MIC Audits, as part of the Medicaid Integrity Program (MIP) are now underway in many regions. MIC Audits are unique, conducted in distinct steps with each managed by a different type of MIC Audit Contractor. Review MICs are data-mining now, looking for coding and billing errors, such as upcoding, medical necessity and uncovered services. Their findings and recommendations will be issued to Audit MICs who will initiate audits including both desk review and on-site audits.

According to some estimates from CMS, the MIC Audits are expected to generate greater recoveries and more revenue than the highly publicized Medicare RAC program. Without the proper tools, healthcare providers and MCOs risk losing legitimate revenues through the MIC Audits.

Join us for this free webinar with Sara Kay Wheeler of King & Spalding LLP. Sara Kay and her team have hands-on experience with MIC audits and related appeal strategy. Her presentation will focus on practical techniques for minimizing the risk of revenue loss as you manage MIC audits and formulate your appeal strategy. The presentation will include:

Case study examples and best practice recommendations from actual MIC audits
Implementing defense strategies, and preparing to manage appeals
Answers to common MIC audit questions

About the Presenter

Sara Kay Wheeler is a partner in King & Spalding’s Healthcare Practice Group. She has extensive experience in the creation and implementation of corporate compliance programs and investigations, government contractor audits (including RACs, MACs, MICs, PSCs and ZPICs), Medicare regulation (including Medicare Part D issues), Medicaid regulation (including audit and enforcement matters), fraud and abuse concerns, internal investigations, voluntary disclosure strategies, clinical research compliance, privacy matters and managed care arrangements. Ms. Wheeler also works with King & Spalding’s Special Matters Group to defend healthcare providers that are investigated by federal and state enforcement entities. Ms. Wheeler is currently serving as a Director on the Health Care Compliance Association (HCCA) Board of Directors and is a past president of the Georgia Academy of Healthcare Attorneys. She has been listed in Chambers USA Guide to America’s Leading Business Lawyers, Best Lawyers in America, Georgia Super Lawyers and Nightingale’s Outstanding Hospital Lawyer’s List.

Join us on Thursday March 25th at 2pm Eastern for "Manage MIC Audits with the Compliance 360 Claims Auditor" and exclusive demonstration of Compliance 360’s Claims Auditor Solution focused on MIC Audits.

Observations from the 2010 RAC Summit

2010-03-16T11:11:00.000-07:00

With the RAC program fully implemented and operational, many of the presentations at this year’s RAC Summit focused on other claims audits like MIC and ZPIC. While RACs main charter is to identify overpayments and underpayments, there appears to be growing emphasis on identifying and correcting fraud, waste, and abuse. Here are some noteworthy takeaways from this year’s RAC Summit:

Unlike RAC audits, where the primary focus is the identification of overpayments, ZPICs target potential fraud and abuse in the Medicare program. Through the ZPICs, the Centers for Medicare & Medicaid (CMS) will have, for the very first time, a contractor with the uniform jurisdiction of auditing the integrity of all Medicare-related claims for a particular provider. Thus, ZPICs will play an increasingly important role in fraud, waste, and abuse detection in the Medicare and Medicaid programs in the coming years.

From the MIC Audit presentation by Sara Kay Wheeler of King & Spalding – with all of the attention garnered by the RACs, MICs have the potential to cause greater disruption to a healthcare provider because they operate under a different set of rules. Here are some of the differences:

RACs – provider outreach is required | MICs provider outreach is not required
RACs – time to produce records is 45 days(or more with extensions) | MICs – time to produce records is much shorter and can vary from State to State
RACs – number of records is limited | MICs – no limit to number of records
RACs – Main focus is on overpayments or underpayments | MICs focus on over/under payments, but also are looking for cases of fraud, waste, and abuse

During the 3-year demonstration project, RACs identified over $1 billion in improper payments. Yet, RACs referred only two cases of potential fraud to CMS during this time. Because RACs do not receive their contingency fees for cases they refer that are determined to be fraud, there may be a disincentive for RACs to refer cases of potential fraud. The Office of the Inspector General is recommending that CMS take the following actions:

Conduct follow-up to determine the outcomes of the two referrals made during the demonstration project
Implement a database system to track fraud referrals
Require RACs to receive mandatory training on the identification and referral of fraud

The Compliance 360 Claims Auditor helps healthcare providers centrally manage CMS audits including RAC, MIC, ZPIC, MAC and more, as well as commercial payor audits. Now licensed for use by hundreds of facilities, the Claims Auditor helps you take control of claims audits to minimize the loss of legitimate revenues and risk of false claims allegations. For more information, please visit www.compliance360.com/healthcare

ZPIC Audits: Steps You Can Take to Minimize the Risk

2010-02-17T07:19:00.000-08:00

Webcast: ZPIC Audits: Steps You Can Take to Minimize the Risk Join us for this enlightening webcast, register here:
http://www.compliance360.com/Mailers/2010Webinar_ZPIC_Feb18.asp

With all of the buzz surrounding RAC (Recovery Audit Contractor) and MIC (Medicaid Integrity Contractor) audits, providers may be overlooking the new ZPIC (Zone Program Integrity Contractor) audits, which has the potential to be equally disruptive to your organization.

Unlike RAC audits, where the primary focus is the identification of overpayments, ZPICs target potential fraud and abuse in the Medicare program. Through the ZPICs, the Centers for Medicare & Medicaid (CMS) will have, for the very first time, a contractor with the uniform jurisdiction of auditing the integrity of all Medicare-related claims for a particular provider. Thus, ZPICs will play an increasingly important role in fraud and abuse detection in the Medicare and Medicaid programs in the coming years. For this reason, providers should understand the role of ZPICs and how to prepare for them.

Join us for a free webinar to learn about approaches and options for healthcare providers seeking to protect themselves from the risks created by the ZPIC program.

During the webinar, you will learn about the following:

Overview and objectives of the ZPIC Program
Key areas of focus for ZPIC audits
How to minimize the risks of triggering a ZPIC audit
Recommendations for preparing for audits
Managing the appeals process to minimize financial risks

Who Should Attend

CFO, CEO
Chief Compliance Officer
Chief Risk Officer
Director of Risk Management
Director of Regulatory Affairs
Hospital Legal/Regulatory Counsel
VP/Director of Revenue Cycle

About the Presenter

Anna Grizzle practices healthcare law at the law firm of Bass Berry & Sims. She works with a broad range of healthcare providers and companies on compliance, operations, reimbursement, and risk management issues. Ms. Grizzle assists clients in developing and implementing compliance programs and frequently counsels clients on compliance-related matters. She also works with clients in conducting internal investigations and frequently represents clients in Medicare, Medicaid and private payor audits and overpayment disputes.

Recent Benchmark Study Suggests Increased Regulatory Oversight Expected in 2010

2010-02-09T12:58:00.000-08:00

By Steve McGraw, President and CEO, Compliance 360

2009 brought an assortment of new regulations and audit challenges for healthcare providers to contend with. Claims audits including RAC and MIC have the potential to erode healthcare providers’ already thin margins and with fines up to $1million the HITECH provisions of the Economic Stimulus Act of 2009 add teeth to HIPAA which was once thought of as just a paper tiger. There has been much speculation as to what 2010 will bring; many leading industry pundits have offered editorial commentary on the Healthcare Reform Bill and how it will impact healthcare providers.

Late last year, Compliance 360 surveyed over 1400 healthcare compliance professionals and summarized the findings in their 2010 Healthcare Compliance Benchmark Study. The data suggests that many healthcare providers are expecting greater regulatory scrutiny in 2010 and have increased their budgets accordingly – nearly a third of all respondents indicated that they expect their budgets to either increase slightly or significantly. You can download a free copy of our 2010 Healthcare Compliance Benchmark by clicking the link below:

2010 Healthcare Compliance Benchmark

Research Compliance - The Unexplored Issues

2010-01-25T07:05:00.000-08:00

The development of new drugs and devices is one of the highest compliance risk areas for the healthcare industry today. Much is at stake for the developers, the providers who perform the research, as well as for the patients waiting for help from industry innovation. Most recently, the industry has seen increased enforcement of clinical trials research regulatory rules, particularly in billing compliance.

Join us for a free educational webinar with research compliance experts from Sonnenschein, Nath & Rosenthal and Meade & Roach.

http://www.compliance360.com/Mailers/Webinar_Research_Jan2010.asp

The presenters will offer practical guidance and discuss case study examples that illustrate:

How to bill for research patients under Medicare Part C
How to bill for research patients under Medicare Part D
False Claims Act Amendments and the implications for historical payments
OHRP Investigations for 2009 and beyond: Important liability implications for the Institutional Official and Human Research Protections Administrator
The importance of having an official "Research Compliance Program" if there is any research done at your organization
Live Q&A with the presenter(s)

Who Should Attend

CFO, CEO
Chief Compliance Officer
Director of Internal Audit
Chief Risk Officer
Director of Risk Management
Director of Legal/Regulatory Counsel

Webcast: HIPAA/HITECH Compliance Benchmark Results

2010-01-07T11:04:00.000-08:00

The session will end with next-step suggestions for HIPAA/HITECH compliance and preparing for inspections by the Office for Civil Rights. A live question and answer session with the presenters will be included.

Webinar attendees will receive access to complimentary copies of the benchmark study and the Crowe Horwath whitepaper “Raising Healthcare Security and Privacy Standards: Complying With HIPAA and the HITECH Act”.
Who Should Attend

* Healthcare Providers, Payors and Business Associates
* Privacy Officer or Director
* Chief Compliance Officer or Director
* HIM Officer or Director
* Security Officer or Director
* Legal/Regulatory Counsel
* CFO, CEO
* Chief Risk Officer or Director

About the Presenters

Dr. Larry Ponemon is the Chairman and Founder of the Ponemon Institute, a research “think tank” dedicated to advancing privacy and data protection practices. Dr. Ponemon is considered a pioneer in privacy auditing and the Responsible Information Management or RIM framework. Dr. Ponemon consults with leading multinational organizations on global privacy management programs. He has extensive knowledge of regulatory frameworks for managing privacy and data security including financial services, health care, pharmaceutical, telecom and Internet. Dr. Ponemon was appointed to the Advisory Committee for Online Access & Security for the United States Federal Trade Commission. He was also appointed by the White House to the Data Privacy and Integrity Advisory Committee for the Department of Homeland Security.

Raj Chaudhary is a Principal and National Practice Leader for the Security and Privacy Practice of Crowe Horwath LLP. Raj is an industry thought leader in the area of privacy and data protection. He consults with major entities in the private and public sector in assisting them with remediation of deficiencies in safeguarding information. He has extensive knowledge of regulatory frameworks for managing security and privacy in multiple industries including financial services, health care and public sector.

Enterprise Risk Management in Healthcare (ERM) - Where is the puck going?

2009-11-30T09:09:00.001-08:00

By Steve McGraw, President and CEO, Compliance 360

Wayne Gretzky was once asked why he was such a great hockey player. He responded by saying that most hockey players went to where the puck is, whereas he skated to where the puck was going to be. So where is the ERM puck going to be in 3 – 5 years?

It is very clear that health systems are just now adopting ERM strategies that are the hallmark of some of the most well respected and admired corporations in the world. Health systems’ boards today are more likely to include business leaders from publicly traded companies, therefore driving the management behavior to adopt the very best practices from the business community.

Recently, I had the privilege of meeting with one of the most respected Chief Compliance Officers in the healthcare industry. The conversation turned to ERM. and I asked him how he defined Was it simply the actions of responding to a bad event such as harmful negligence or was he looking to manage risk across the enterprise in a proactive way that was connected to the business strategy? He quickly jumped on the question, stating the latter, and then proceeded to recite the COSO II definition almost verbatim.

I am seeing this trend more and more as I meet with our customers and other healthcare industry executives. This anecdotal data is supported by a recent healthcare poll we conducted in which I found the results very interesting. Of the 237 individuals that responded, nearly 40% said that ERM was a strategic priority now and 18% said it would be a priority in 2010. But only 7% described their current ERM practice as “robust and consistently applied across the enterprise.” So, what can we conclude from these results? Hospitals face a myriad of risks today – RAC, ZPICs, MACs, Obama-Care, crippled credit markets, staff shortages, and pandemics like H1N1 are just a few of the items that come to mind. How can a billion dollar enterprise possibly manage these systemic risks? They will be well served by adopting the same ERM practices embraced by other industries. I believe that by 2015 only the laggards in the healthcare industry will not have an ERM practice in their health systems.

About Compliance 360

Compliance 360 is the leading provider of enterprise governance, risk management and compliance solutions for healthcare providers. With these solutions, healthcare providers reduce risks, improve efficiencies and protect their brands using a single platform to address their comprehensive GRC requirements. The Compliance 360 solution for healthcare addresses the need for policy management, centralized regulatory management, Joint Commission Accreditation, corporate integrity agreements, adverse-event management, contract management, Medicare CMS RAC audits, self assessments, and enterprise risk management.

Living with RAC: Moving Forward While Looking Back from Compliance 360

2009-11-23T11:46:00.000-08:00

Webcast:

Living with RAC: Forward While Looking Back

Please mark your calendars and save the date for this educational webinar on the latest operational recommendations for successfully managing RAC audits and appeals. Day Egusquiza, the presenter for our prior educational RAC webinars, will share her findings from RAC audits so far, and include best practice suggestions for identifying and addressing audit vulnerabilities. Case study examples from recent RAC audits will be used to illustrate the findings and recommendations.

Who Should Attend

• CFO, CEO
• Chief Compliance Officer
• Compliance Director
• Chief Risk Officer
• Director of Risk Management
• Director of Regulatory Affairs
• Hospital Legal/Regulatory Counsel
• VP/Director of Revenue Cycle

About the Presenter

Evolving to Outcome-Based Accreditation

2009-10-28T11:52:00.000-07:00

Since the days of leisure suits, pet rocks and double-digit interest rates, widely used quality assessment and accreditation processes in healthcare have remained virtually unchanged. With rising error rates and falling success rates in terms of measured outcomes, there is a compelling need for a transition to outcome-based quality assessment and accreditation techniques.

Many in the healthcare industry are discovering that quality management techniques, widely proven in other industries, can be leveraged by healthcare providers to achieve outcome-based oversight and improve results by creating new standards of excellence from the skills, experience and ingenuity that already exist in their hospitals.

To learn more about this concept, tune into Compliance 360's free webinar:

Evolving to Outcome-Based Accreditation: Using Proven Quality Management Techniques

The presentation will help you:

• Understand the rationale for the need for a new accreditation alternative

• Learn about a contemporary alternative to outdated hospital accreditation processes

• Understand the ease of transition to an alternative accreditation organization

• Learn how to apply outcome-oriented ISO 9001:2000 quality management system requirements

• Learn how to develop a quality system infrastructure to improve the performance of an organization at all levels

Who Should Attend

CFO, CEO
Chief Compliance Officer
Chief Risk Officer
Director of Risk Management
Director of Regulatory
Affairs Hospital Legal/Regulatory Counsel

About the Presenter:

Patrick Horine, MHA
Executive Vice President, Accreditation
DNV Healthcare, Inc.

Patrick is responsible for oversight and management of the National Integrated Accreditation of Healthcare Organizations (NIAHO) program for DNV Healthcare, Inc. He oversees the staff and surveyors including standards development, providing pre-survey support, evaluation of survey activities, and post-survey activities, which includes the evaluation of the reporting process and review of corrective actions to survey findings. He has been in an integral role for the development of the NIAHO Accreditation Program pursuant to recognition of deeming authority from the Centers for Medicare and Medicaid Services (CMS).

Patrick has more than 20 years of healthcare management experience and holding leadership positions in hospitals. His experience includes positions as Chief Executive Officer, Chief Operating Officer, and Vice President for Quality and Business Development. His expertise includes hospital operations, performance improvement, patient safety, data inventory development and analysis, and adverse event investigations. He has presented numerous seminars as well as worked on-site with healthcare organizations on an international level.

Patrick’s educational background includes a master’s degree in hospital and health administration from Xavier University, and a Bachelor of Science degree in health occupations education from the University of Louisville.

Compliance 360 Launches Privacy Breach Management Solution

2009-10-20T11:38:00.000-07:00

Online Solution Available for Free Use by up to 100 Healthcare Provider and Insurance Organizations

Atlanta, GA. – October 20, 2009 – Compliance 360, a leading provider of Software-as-a-Service (SaaS) solutions for enterprise governance, risk management and compliance (eGRC) announced today the availability of the Compliance 360 HITECH Privacy Breach Management Solution. This new solution from Compliance 360 is used by healthcare providers and health insurance companies as their system of record for managing suspected privacy breaches, facilitating investigations, completing timely notifications of affected parties and maintaining an audit-ready state as required by the Health Information Technology for Economic and Clinical Health (HITECH) Act passed as part of the American Recovery and Reinvestment Act of 2009 (ARRA).

The privacy breach management regulations in the HITECH Act create significant new compliance risks for healthcare providers, health plans and their business associates that have access to protected health information (PHI) data. In response to these new regulatory burdens, Compliance 360 is making a limited use version of its HITECH Privacy Breach Management Solution available for free usage, for a period of up to one year, for up to 100 organizations.

“Faced with increasing compliance risks created by the HITECH Act, and a clear need among healthcare providers and health plans to mitigate these risks, we’ve mobilized to quickly bring this new solution to the market,” said Steve McGraw, president and CEO of Compliance 360. “Because we recognize that the healthcare industry also faces unprecedented cost pressures, we’ve decided to make the HITECH Privacy Breach Management Solution available for free to a broad number of organizations. By taking advantage of the free-use program, we believe that healthcare providers and insurance companies can benefit immediately by reducing their compliance risks. Many of them, for the first time, will also be able to experience the power of the healthcare industry’s leading GRC solutions from Compliance 360.”

Healthcare and insurance companies interested in participating in the Compliance 360 HITECH Privacy Breach Management free-use program should contact Breach.Management@compliance360.com.

About Compliance 360 for Healthcare
Compliance 360 is the leading provider of enterprise governance, risk management, compliance and audit management solutions for healthcare industries. With these solutions, healthcare providers and health plans reduce risks, improve efficiencies and protect their brands using a single platform to address their comprehensive GRC requirements. The Compliance 360 solution for healthcare addresses the need for policy management, centralized regulatory management including HITECH, HIPAA, EMTALA, STARK and others, accreditation, OIG corporate integrity agreements (CIA), False Claims Act (FCA) compliance, adverse-event management, contract management, surveys, remediation projects, claims audits and denials, Medicare RAC audits, Medicaid MIC Audits, self assessments, and enterprise risk management. Industry leading healthcare providers and health plans that depend on Compliance 360 include AMERIGROUP, Billings Clinic, Centene Corporation, Catholic Healthcare Systems, Health Net, IASIS Healthcare, InterDent, Jackson Memorial Hospital, LHC Group, Methodist Hospital, MultiCare Health System, Nassau University Medical Center, Rush Health Systems, Saint Joseph's Hospital of Atlanta, St. Elizabeth Medical Center, St. Luke's Health System, WellPoint, and more than 31 Blue Cross Blue Shield organizations. To learn more about Compliance 360, visit www.compliance360.com.

Editor’s Note: Compliance 360 is a registered trademark of Compliance 360, Inc. Virtual Evidence Room is a registered service mark of Compliance 360, Inc. Any other trademarks are recognized as proprietary to their owners.

7.6 Release

2008-05-30T11:34:00.000-07:00

The 7.6 Release incorporates Second Generation Regulatory content management