Compliance - The Learning Academy

Compliance Consulting

Compliance Program Design

We can design a compliance program that meets the standards set by HHS OIG, CMS, healthcare insurance companies, managed care organizations, including Community Behavioral Health in Philadelphia. We serve healthcare organizations, such as psychotherapy clinics and private practices, home care agencies, home health agencies, and drug and alcohol treatment centers.

Program Implementation

A compliance program is a system of processes, policies, procedures, and controls that ensure that the company follows all required rules, regulations, contracts, and policies. An effective compliance program addresses an organization’s culture by helping employees and vendors speak up and do the right thing. An effective compliance program follows a rhythm of education, prevention, detection, enforcement, and correction.

Program Assessment

An assessment assures the organization that its compliance program is effective and adheres to OIG and CMS requirements.

Adhering to its compliance program provides demonstrable evidence that the company lives and breathes its values and ethics.

Compliance Training

We can design, implement and conduct a comprehensive training program that addresses the risks your organization identified through its risks assessment.

a. Fraud, waste, and abuse
b.       Privacy and Confidentiality
c.       Anti-kick
d.       Bribery
e.       Whistleblower laws
f.        Nonretaliation
g.       Insurance billing and claims
h.       Professional development

Auditing and Monitoring

Auditing and monitoring are critical activities that alert an organization to rising concerns in compliance areas. An effective auditing and monitoring program employs systematic and consistent controls.

a. We can provide internal monitoring using critical metrics based on an organization’s unique needs and risks
b. We can design and implement an organization’s internal auditing plan

Compliance Communication

We can develop and implement your compliance communication plan, such as:

a.       Hotline monitoring
b.       Compliance newsletters and reminders
c.       Employee and vendor compliance surveys
d.       Monitoring changes to compliance regulations and laws

Investigations

We can investigate compliance issues and develop a corrective action plan to resolve the issue and prevent future occurrences.

a. After investigation or audit, identify the missing or failed control to allow the issue to develop.
b. After identifying the missing or failed control, develop a corrective action plan to address the issue.

How does it work

For example, we can audit 30 days of your insurance claim for psychotherapy. As a result of our audit, we find that 10% of your claims included claims where your therapists signed their notes 30 days after the session. In that case, our investigation may reveal that someone disabled your electronic billing system’s feature that flags claims with signature over 30 days.

After our audit, we would produce a written report outlining our findings, recommendations, and corrective action plan.

Corrective Action Plans

Our corrective action plan would offer real-world recommendations, individualized training for staff, and a community-wide campaign about the importance of speaking up.

Get Started Today

Designing and monitoring an effective compliance program is necessary
but time-consuming and stressful. We can help.