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	<title>Case Study » YouCompli</title>
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		<title>Helping hospital systems know how to implement the No Surprises Act</title>
		<link>https://youcompli.com/blog/case-study/how-to-implement-the-no-surprises-act/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=how-to-implement-the-no-surprises-act</link>
		
		<dc:creator><![CDATA[Editor]]></dc:creator>
		<pubDate>Tue, 22 Mar 2022 01:02:37 +0000</pubDate>
				<category><![CDATA[Case Study]]></category>
		<category><![CDATA[How To]]></category>
		<category><![CDATA[Revenue Cycle]]></category>
		<category><![CDATA[Tips]]></category>
		<guid isPermaLink="false">https://youcompli.com/?p=5446</guid>

					<description><![CDATA[<p>Hospital systems knows regulatory changes created by the No Surprises Act and what to do for a successful implementation.</p>
<p>The post <a href="https://youcompli.com/blog/case-study/how-to-implement-the-no-surprises-act/">Helping hospital systems know how to implement the No Surprises Act</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></description>
										<content:encoded><![CDATA[<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='Helping hospital systems know how to implement the No Surprises Act' data-link='https://youcompli.com/blog/case-study/how-to-implement-the-no-surprises-act/' data-summary='Hospital systems knows regulatory changes created by the No Surprises Act and what to do for a successful implementation.' data-app-id-name='category_above_content'></div>
<h1 class="wp-block-heading">Executive Summary</h1>



<p>Many provisions of the No Surprises Act – which went into effect on Jan. 1, 2022 – required extensive training, education, and communications for healthcare organizations to demonstrate compliance. Most chief compliance officers anticipated obstacles as they prepared their healthcare organizations to implement the complex law.</p>



<p>The rollout has not been easy for many hospital systems. It was tough for CCOs to know about all the regulatory changes in the complicated law and what to do to comply with it.</p>



<p>YouCompli resources, such as relevance questions and model policies and procedures, helped CCOs know how to best prepare their organizations.</p>



<h4 class="wp-block-heading">YouCompli helped hospital systems know any and all regulatory changes created by the No Surprises Act and what they needed to do for a successful implementation.</h4>



<h1 class="wp-block-heading">The Challenge</h1>



<p>Most chief compliance officers expected obstacles as they prepared their healthcare organizations to implement the No Surprises Act. Many provisions of the complex law – which went into effect on Jan. 1, 2022 – required extensive training, education, and communications for healthcare organizations to demonstrate compliance.</p>



<p>The law aims to simplify billing by increasing transparency and to decrease unexpected bills for patients. But the rollout has not been easy for many hospital systems.</p>



<p>“I applaud the goal of the bill, but the path to get there is burdensome for hospitals,” said the director of corporate compliance and privacy officer at an East Coast health system.</p>



<p>She summarized the challenges hospital systems face in complying with the No Surprises Act.</p>



<p>“If we don’t inform patients and get their consent to bill them, hospitals are stuck with the unpaid balances,” she said. “Those unpaid balances have always been a risk, of course. But now we have extra work to get to the same place – trying to figure out what the charges are and making sure patients know what they are. And we’ve got to get their approval to charge when necessary.”</p>



<p>Knowing what would change and how to comply was overwhelming, given the scope of the No Surprises Act. That’s where YouCompli came in.</p>



<h1 class="wp-block-heading">The Solution</h1>



<p>Knowing which changes were coming – and what to do about them – was time consuming for this CCO. And the timing could not have been worse. CCOs like her were preparing for the No Surprises Act during yet another pandemic surge. It was tough for CCOs to know what do, particularly when their colleagues were focused on patient care and not easily accessible to weigh in.</p>



<p>YouCompli provided several resources for knowing how to prepare healthcare organizations to comply with provisions of the No Surprises Act.</p>



<p>For example, the succinct relevance questions written by YouCompli analysts helped CCOs know whether changing regulations pertained to their organization. The relevance questions also guided CCOs to know what questions to ask of their colleagues.</p>



<p>The East Coast director of corporate compliance and privacy officer found the relevance questions helpful. “You can determine very quickly if you need to do anything further with a reg change or not,” she said.</p>



<p>Also, YouCompli’s model policies and procedures helped her know what to do about the changes. Her organization’s Revenue Cycle department found these resources especially valuable.</p>



<p>“I worked closely with our Revenue Cycle folks; there was a lot of back and forth with them,” she explained. “They were really the ones principally responsible for implementation of the No Surprises Act.”</p>



<p>Her Revenue Cycle colleagues appreciated having all the model policies and procedures in one place.</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“There was no, Do we need to do this, do we need to do that?” she said. “It was like having a cookbook and a recipe to follow.”</p>
<cite>Director of Corporate Compliance and Privacy Officer an East Coast health system</cite></blockquote>



<p>With YouCompli helping her know how to comply with the No Surprises Act, she was able to deliver more value to the entire hospital system.</p>



<h1 class="wp-block-heading">The Impact</h1>



<p>“With the No Surprises Act, YouCompli resources were so valuable for helping us get up to speed with that big change,” she added. “YouCompli was the safeguard; it was my safety net.”</p>



<p>She said having all the resources available in one place saved time. And with YouCompli, she knew whether a change was relevant without dedicating hours to reading regulations.</p>



<p>“All the consents and notices were right at my fingertips, all together,” she said. “I just had to open the notice, and there was everything we needed. It really saved hours of work.”</p>



<p>She said using YouCompli makes her job easier: “It’s like you have an extra person doing research that’s not on your staff – and that you don’t have to do performance evaluations for or pay benefits for.”</p>



<p>YouCompli also makes demonstrating compliance easier for CCO Scott Borsuk of Western Maryland Health Systems. He said YouCompli helps him stay ahead of fines and demonstrate the value of what the compliance function brings to the larger organization.</p>



<p>Both are crucial for complex regulatory changes like the No Surprises Act. Borsuk also appreciates how YouCompli can generate an end-to-end audit trail, tracking all compliance decisions and activity. If needed, YouCompli can easily prove how his organization has complied with a change.</p>



<p>“I’d look within YouCompli, figure out what changed, when the change was sent to us, and there’s a whole audit trail,” Borsuk said.</p>



<p>He said YouCompli helps him easily know who sent a change, how his organization implemented it, and how the charge master was updated. Borsuk added that YouCompli resources help him know about subtle changes, like coding changes or diagnoses changes in a local coverage determination, or LCD.</p>



<p>“If there’s a change made in an LCD, the burden is on us” to know about it and comply with it, Borsuk explained.</p>



<p>Whether it’s a coding change or extensive regulatory modifications like the No Surprises Act, YouCompli helps CCOs know what’s changing and how to manage it. By helping CCOs know what to do and how to do it, the comprehensive YouCompli solution helps them elevate their hospital system’s compliance function.</p>



<p>“In the compliance world, we all seek peace of mind because of the burdensome, constantly changing regulatory environment,” said the East Coast compliance officer. “That’s what keeps compliance officers up at night: ‘Did I miss some- thing?’ With YouCompli, somebody has your back.”</p>



<p>YouCompli has been a critical resource for hospital systems to know how to successfully implement the No Surprise Act. The law is a work in progress, and YouCompli will continue to support healthcare organizations in knowing what’s changing and how to comply.</p>



<h5 class="wp-block-heading"><a href="https://youcompli.com/blog/know-never-miss-a-relevant-regulatory-change/" title="Find out how you can use YouCompli to know">Find out how you can use YouCompli to know</a> about regulatory changes that affect your organization and make sure those regulations are translated into policies and procedures that affect patient care. </h5>



<h5 class="wp-block-heading">YouCompli customers have access to notifications about changes to regulations, resources to inform policy and procedure updates, and tools to track compliance.</h5>



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<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='Helping hospital systems know how to implement the No Surprises Act' data-link='https://youcompli.com/blog/case-study/how-to-implement-the-no-surprises-act/' data-summary='Hospital systems knows regulatory changes created by the No Surprises Act and what to do for a successful implementation.' data-app-id-name='category_below_content'></div><div style='display:none;' class='shareaholic-canvas' data-app='recommendations' data-title='Helping hospital systems know how to implement the No Surprises Act' data-link='https://youcompli.com/blog/case-study/how-to-implement-the-no-surprises-act/' data-summary='Hospital systems knows regulatory changes created by the No Surprises Act and what to do for a successful implementation.' data-app-id-name='category_below_content'></div><p>The post <a href="https://youcompli.com/blog/case-study/how-to-implement-the-no-surprises-act/">Helping hospital systems know how to implement the No Surprises Act</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></content:encoded>
					
		
		
			</item>
		<item>
		<title>Hospital system manages regulatory changes through massive disruption</title>
		<link>https://youcompli.com/blog/case-study/hospital-manages-regulatory-change/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=hospital-manages-regulatory-change</link>
		
		<dc:creator><![CDATA[Editor]]></dc:creator>
		<pubDate>Tue, 22 Mar 2022 01:02:00 +0000</pubDate>
				<category><![CDATA[Case Study]]></category>
		<category><![CDATA[Regulatory Change Management]]></category>
		<guid isPermaLink="false">https://youcompli.com/?p=5415</guid>

					<description><![CDATA[<p>Struggling to manage the volume, speed, and scope of healthcare regulatory changes. Hospital manages regulatory change during and after COVID.</p>
<p>The post <a href="https://youcompli.com/blog/case-study/hospital-manages-regulatory-change/">Hospital system manages regulatory changes through massive disruption</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></description>
										<content:encoded><![CDATA[<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='Hospital system manages regulatory changes through massive disruption' data-link='https://youcompli.com/blog/case-study/hospital-manages-regulatory-change/' data-summary='Struggling to manage the volume, speed, and scope of healthcare regulatory changes. Hospital manages regulatory change during and after COVID.' data-app-id-name='category_above_content'></div>
<h1 class="wp-block-heading">Executive Summary</h1>



<p>When the pandemic hit, a California-based hospital system was inundated by COVID-19 caseloads and related pressures. Its Compliance function was overwhelmed too, struggling to manage the volume, speed, and scope of regulatory changes coming in.</p>



<p>Further complicating the situation: Regulators were modifying how they announced changes. With changes posted to new websites that were tough to find, the fear of missing a change was real.</p>



<p>Another challenge was the health system’s decentralized model for managing regulatory compliance. This made it difficult to decide who needed to know about a change and who should take action to comply.</p>



<p>By implementing YouCompli, the Compliance function delivered much greater value to the hospital system.</p>



<p>YouCompli enabled the Compliance function to strengthen its approach to managing regulatory change. YouCompli helped the hospital system improve monitoring, effectively communicate changes to all stakeholders, and track the entire process.</p>



<p><strong>Read how YouCompli empowered the Compliance department to better manage regulatory change and deliver greater value to the hospital system.</strong></p>



<h1 class="wp-block-heading">The Challenge</h1>



<p>Managing healthcare regulatory changes is a balancing act for chief compliance officers (CCO). While monitoring changes from federal, and state and local regulators, they’re also convincing colleagues focused on patient care to prioritize compliance.</p>



<p>For a California-based health system, the COVID pandemic laid bare the need to strike a better balance.</p>



<p>The Compliance department was overwhelmed by the volume, speed, and scope of regulatory changes coming from federal and state regulators during the pandemic. The CARES Act, for example, involved hundreds of changes to existing regulations, added new regulations, and created new loan programs and oversight mechanisms.</p>



<p>Another challenge was the health system’s decentralized model for managing regulatory compliance. The Compliance department was responsible for the program’s oversight, project management, and support. But individual departments handled the day-to-day management of regulatory requirements.</p>



<p>This put ongoing responsibility for monitoring, interpreting, and implementing regulatory changes and new regulations at the department level. This approach made it difficult to decide who needed to know about a change and who should take action to comply.</p>



<p>When COVID hit, the Compliance department faced a third problem: Regulators modified how they announced changes. They sometimes posted updates on new websites that were tough to find, including a separate COVID webpage. CCOs unaware of the new webpage missed out on new and changing regulations.</p>



<p>Overwhelmed by COVID caseloads and associated pressures, the hospital system needed better ways to:</p>



<ul class="wp-block-list">
<li>Monitor regulatory changes</li>



<li>Communicate changes to all stakeholders</li>



<li>Manage and track the entire process</li>
</ul>



<p>In the midst of COVID chaos, it was critical for the hospital system to strengthen its Compliance function. That’s where YouCompli came in.</p>



<h1 class="wp-block-heading">The Solution</h1>



<p>Monitoring regulatory change is time consuming even when a hospital system isn’t in crisis mode. The staggering volume of regulatory changes coming in during the pandemic further complicated the monitoring process.</p>



<p>Deciding who needs to know about changes and who should take action to comply was tougher too. When CCOs’ colleagues are continually overwhelmed with patient care, they are not easily accessible.</p>



<p>Adopting YouCompli strengthened the California- based provider’s system and approach for managing regulatory change. A key was enabling the Compliance function to easily identify and document new regulations, even those posted in unfamiliar places. YouCompli analysts read all new and changed regulations in their entirety and flag relevant changes, regardless of where they’re posted.</p>



<p>By relying on YouCompli to handle monitoring, the Compliance department knew that they weren’t missing anything. YouCompli ensured that the hospital system knew what was changing. YouCompli also helped the Compliance department decide who needed to know about a change and which tasks needed to be performed to comply.</p>



<p>For each requirement associated with a regulation, YouCompli creates a few relevance questions. Users may be asked, “Is your organization is a Medicare contractor?” or other pointed questions that help them decide whether a regulation applies to them.</p>



<p>CCOs can answer a question directly or assign it to the appropriate person to answer. YouCompli maintains a directory of subject matter experts who provide compliance leadership within their departments.</p>



<p>YouCompli tracks the responses, including who answered and when. Then YouCompli prompts users through the decision process and to the next steps in their workflow.</p>



<p>This approach made it easy for the Compliance department to communicate changes to all stakeholders.</p>



<p>Also, YouCompli translates technical legal documents into easy-to-understand business requirements. Whether it’s changing a code, completing a form, or modifying a policy or procedure, YouCompli helped the Compliance department decide what to do.</p>



<p>With YouCompli tracking the entire process, the Compliance department had an audit trail of what needed to be done and who had responsibility.</p>



<p>Adopting YouCompli helped the Compliance team cleanly manage the hospital system’s response to regulatory change and ultimately elevate the Compliance function.</p>



<h1 class="wp-block-heading">The Impact</h1>



<p>Though inundated by COVID caseloads and related pressures, the hospital system couldn’t afford to wait to strengthen its approach to managing regulatory change. Without YouCompli, the hospital system may have missed new or changing regulations or lost track of its response to them.</p>



<p>It was a heightened concern given the extraordinary volume of regulatory changes coming in during the pandemic. It was made more complicated by regulators modifying where they posted changes.</p>



<p>Failing to comply with changing regulations could have sunk the organization in increased risk and liability, as pandemic caseloads were threatening to do the same.</p>



<p>Implementing YouCompli enabled the hospital system to act from a position of strength. The comprehensive system YouCompli provided for monitoring new and changing laws and regulations, allowing the Compliance department to no longer worry about missing changes.</p>



<p>Also, YouCompli tools helped the Compliance function easily identify who needed to know about changes and what they should to do comply. Being able to effectively communicate to all stakeholders – during the chaotic early days of the pandemic – was critical for the hospital system.</p>



<p>Finally, YouCompli tracked all the changes the hospital system made. This provided an efficient way to revert when regulators rolled back pandemic-era regulations. If regulators sunset a notice, YouCompli flags it and provides a customized series of questions for the hospital system to answer.</p>



<p>YouCompli also explains what the hospital system needs to do to ensure that it makes the changes to revert to pre-pandemic processes. Using YouCompli to communicate helps everyone in the hospital system see when tasks are completed. Users can attest that they’ve done it, and it’s all tracked in YouCompli.</p>



<p>With YouCompli handling all these steps, the California-based health system strengthened its approach to managing regulatory changes – remarkably &#8211; during a pandemic. The comprehensive YouCompli solution helped the Compliance department deliver greater value to the hospital system. With YouCompli, the health system’s Compliance function evolved from chaos to confidence. YouCompli tools helped the Compliance function easily identify who needed to know about changes and what they should to do comply.</p>



<p><a href="https://youcompli.com/blog/manage-involve-colleagues-to-ensure-your-organization-complies-with-regulatory-changes/" title="Find out how you can use YouCompli to manage">Find out how you can use YouCompli to manage</a> your organization&#8217;s response to regulatory changes. </p>



<p><strong>YouCompli customers have access to notifications about changes to regulations, resources to inform policy and procedure updates, and tools to track compliance.</strong></p>



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<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='Hospital system manages regulatory changes through massive disruption' data-link='https://youcompli.com/blog/case-study/hospital-manages-regulatory-change/' data-summary='Struggling to manage the volume, speed, and scope of healthcare regulatory changes. Hospital manages regulatory change during and after COVID.' data-app-id-name='category_below_content'></div><div style='display:none;' class='shareaholic-canvas' data-app='recommendations' data-title='Hospital system manages regulatory changes through massive disruption' data-link='https://youcompli.com/blog/case-study/hospital-manages-regulatory-change/' data-summary='Struggling to manage the volume, speed, and scope of healthcare regulatory changes. Hospital manages regulatory change during and after COVID.' data-app-id-name='category_below_content'></div><p>The post <a href="https://youcompli.com/blog/case-study/hospital-manages-regulatory-change/">Hospital system manages regulatory changes through massive disruption</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></content:encoded>
					
		
		
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		<title>Hospital system elevates its approach to deciding when regulations are relevant</title>
		<link>https://youcompli.com/blog/case-study/decide-relevant-healthcare-regulations/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=decide-relevant-healthcare-regulations</link>
		
		<dc:creator><![CDATA[Editor]]></dc:creator>
		<pubDate>Tue, 22 Mar 2022 01:00:38 +0000</pubDate>
				<category><![CDATA[Case Study]]></category>
		<category><![CDATA[How To]]></category>
		<guid isPermaLink="false">https://youcompli.com/?p=5325</guid>

					<description><![CDATA[<p>An endless stream of new and changing laws requires chief compliance officer, Scott Borsuk to decide relevant healthcare regulations for the hospital</p>
<p>The post <a href="https://youcompli.com/blog/case-study/decide-relevant-healthcare-regulations/">Hospital system elevates its approach to deciding when regulations are relevant</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></description>
										<content:encoded><![CDATA[<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='Hospital system elevates its approach to deciding when regulations are relevant' data-link='https://youcompli.com/blog/case-study/decide-relevant-healthcare-regulations/' data-summary='An endless stream of new and changing laws requires chief compliance officer, Scott Borsuk to decide relevant healthcare regulations for the hospital' data-app-id-name='category_above_content'></div>
<h1 class="wp-block-heading">Executive Summary</h1>



<p>As chief compliance officer for a hospital system, Scott Borsuk faced a two-fold challenge. He was overwhelmed by the endless stream of new and changing laws and regulations coming in. Deciding if changes pertained to his organization was an even bigger struggle.</p>



<p>Implementing YouCompli helped his compliance function to deliver greater value to the hospital system.</p>



<p>In fact, on day one of implementation, YouCompli flagged a billing regulation that would have otherwise been missed. The benefits of YouCompli multiplied from there.</p>



<p>Borsuk no longer dedicates hours to reading regulations and deciding if a change is relevant to his hospital. YouCompli handles these steps for him. Whether it’s changing a code to match a regulatory change, completing a form, or modifying a policy or procedure, YouCompli helps Borsuk decide what regulations apply to him know what he needs to do to comply.</p>



<h4 class="wp-block-heading"><strong>YouCompli empowered Borsuk to make better informed compliance decisions and deliver greater value.</strong></h4>



<h1 class="wp-block-heading">The Challenge</h1>



<p>The complexities and challenges of managing compliance risks for a hospital system are endless. As chief compliance officer for Western Maryland Health System, Scott Borsuk faced a two-fold challenge.</p>



<p>He was overwhelmed by the volume of new and changing laws and regulations coming in. Deciding if changes pertained to his organization presented an even trickier challenge.</p>



<p>“We run pretty lean,” he explained. “Our surgery director, or emergency department or pharmacists – they don’t have a lot of time. And they’re trained to be clinicians. We don’t want them spending time reading regulations and figuring out what to do to comply.”</p>



<p>He relied on an alerting tool to notify him when language in existing regulations and laws changed. But he said it was “cumbersome.” And it did not flag specific changes or indicate if they were relevant to Borsuk’s organization.</p>



<p>As a result, he was required to read an entire national coverage determination, for example, to look for modifications.</p>



<p>“It’s not enjoyable reading,” Borsuk noted.</p>



<p>Even if Borsuk decided a change was relevant to his organization, he faced another problem. He had to decide who among his 2,300 colleagues should implement new policies or procedures in order to comply.</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“I probably spent six to eight hours a week reading regulations, then copying and pasting them&#8221; to share with colleagues, Borsuk said. “It took a lot of my time.”</p>
</blockquote>



<p>He also worried about missing a change in a regulation or law. “We were not confident that we were catching everything,” Borsuk said. “We had the documents but didn’t know if we missed anything. At the end of the day, we didn’t know if we were making the right changes or not.”</p>



<p>Borsuk knew he needed a better system and a stronger approach to managing regulatory change. That’s where YouCompli came in.</p>



<h1 class="wp-block-heading">The Solution</h1>



<p>Deciding if a change is relevant is time consuming, and it can be a tough call for CCOs to make.</p>



<p>Especially when their colleagues are focused on patient care and may not be easily accessible to weigh in.</p>



<p>With YouCompli, Borsuk can easily decide if a regulation relates to his hospital system and how to comply.</p>



<p>YouCompli analysts read entire regulations and flag relevant changes and translate technical legal documents into easy-to-understand business requirements. YouCompli also provides tools to help decide which changes apply and which tasks need to be performed to comply.</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“YouCompli tells you exactly what to do,” Borsuk said.</p>
</blockquote>



<p>For each requirement associated with a regulation, YouCompli creates a few relevance questions.Users may be asked, for instance, Is your organization is a Medicare contractor?</p>



<p>CCOs can answer a question directly or assign it to the appropriate person to answer. YouCompli maintains a directory of subject matter experts who provide compliance leadership within their departments.</p>



<p>YouCompli tracks the responses, including who answered and when. YouCompli uses these responses to decide whether a regulation pertains to an organization. Then YouCompli software prompts users through the decision process and to the next steps in their workflow.</p>



<p>The comprehensive YouCompli solution helped elevate the compliance function at Western Maryland.</p>



<h1 class="wp-block-heading">The Impact</h1>



<p>On day one of implementation, YouCompli saved Western Maryland from missing a billing-related local coverage determination, or LCD.</p>



<p>Days before Western Maryland went live on YouCompli, a hospital director saw that an LCD had been issued for services now deemed “not reasonable and necessary.” But she misunderstood the changes in the regulation and didn’t believe they were applicable.</p>



<p>The day that Western Maryland implemented YouCompli, the hospital director received a notifi- cation about the LCD. But she closed it, mistakenly thinking it was irrelevant. When Borsuk noticed she had not answered YouCompli’s relevance questions, he asked her to do so.</p>



<p>They quickly realized the LCD was indeed applicable. They used YouCompli’s model policies and procedures to ensure they were in compliance.</p>



<p>YouCompli saved them from possible delay or denial in payment from the Centers for Medicare and Medicaid Services. (CMS).</p>



<p>The benefits of implementing YouCompli have multiplied since the day-one discovery of the relevant LCD. Borsuk no longer dedicates hours to reading regulations and deciding if a change is relevant. YouCompli handles these steps for him. Whether it’s changing a code, completing a form, or modifying a policy or procedure, YouCompli helps Borsuk decide what to do to comply.</p>



<p>“I may just get a Word doc saying, ‘all you have to do is change this code,’” he said. “I don’t have to do a thing. If it comes into me, let’s say for orthopedic surgery, the person who runs our surgery depart- ment is copied. I assign it to him, and he runs with it. I get notified he’s accepted it, and it’s done. The audit trail is there. It took a convoluted process and made it idiot proof.”</p>



<p>Nearly four years after Borsuk implemented YouCompli, he remains convinced it was the right choice. Though return on investment can be tough to calculate, Borsuk noted YouCompli costs less than the competitor he had been using. “I didn’t have to cost justify a thing. We are continually demonstrating how the Compliance function delivers value for the hospital, rather than playing catch up.”</p>



<p>Relying on YouCompli to monitor regulations and help him decide when changes are relevant also saved Borsuk time. He estimates he got back one day per week. YouCompli also has enabled his colleagues to focus on managing patient care.</p>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">
<p>“Our folks love it,” Borsuk said. “They thought YouCompli was a godsend; I can’t imagine why any compliance professional would not want it.” “If there’s a regulatory change, you know exactly what to do and you can track whether it’s done or not,” Borsuk said. “We have confidence that any time there’s a healthcare rule, law, or regulation that changes, we’re catching it.”</p>
</blockquote>



<h3 class="wp-block-heading"><a href="https://youcompli.com/blog/decide-use-youcomplis-focused-decision-criteria-to-quickly-decide-if-a-regulation-is-relevant-to-your-organization/" title="Find out how you can use YouCompli to decide">Find out how you can use YouCompli to decide</a> which regulatory changes apply to you. </h3>



<h3 class="wp-block-heading">YouCompli customers have access to notifications about changes to regulations, resources to inform policy and procedure updates, and tools to track compliance.</h3>



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<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='Hospital system elevates its approach to deciding when regulations are relevant' data-link='https://youcompli.com/blog/case-study/decide-relevant-healthcare-regulations/' data-summary='An endless stream of new and changing laws requires chief compliance officer, Scott Borsuk to decide relevant healthcare regulations for the hospital' data-app-id-name='category_below_content'></div><div style='display:none;' class='shareaholic-canvas' data-app='recommendations' data-title='Hospital system elevates its approach to deciding when regulations are relevant' data-link='https://youcompli.com/blog/case-study/decide-relevant-healthcare-regulations/' data-summary='An endless stream of new and changing laws requires chief compliance officer, Scott Borsuk to decide relevant healthcare regulations for the hospital' data-app-id-name='category_below_content'></div><p>The post <a href="https://youcompli.com/blog/case-study/decide-relevant-healthcare-regulations/">Hospital system elevates its approach to deciding when regulations are relevant</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></content:encoded>
					
		
		
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		<title>Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date</title>
		<link>https://youcompli.com/blog/case-study/compliance-a-trusted-business-partner-verify-healthcare-compliance/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=compliance-a-trusted-business-partner-verify-healthcare-compliance</link>
		
		<dc:creator><![CDATA[Editor]]></dc:creator>
		<pubDate>Tue, 22 Mar 2022 00:59:00 +0000</pubDate>
				<category><![CDATA[Case Study]]></category>
		<category><![CDATA[How To]]></category>
		<category><![CDATA[Revenue Cycle]]></category>
		<guid isPermaLink="false">https://youcompli.com/?p=5463</guid>

					<description><![CDATA[<p>Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date</p>
<p>The post <a href="https://youcompli.com/blog/case-study/compliance-a-trusted-business-partner-verify-healthcare-compliance/">Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></description>
										<content:encoded><![CDATA[<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date' data-link='https://youcompli.com/blog/case-study/compliance-a-trusted-business-partner-verify-healthcare-compliance/' data-summary='Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date' data-app-id-name='category_above_content'></div>
<h1 class="wp-block-heading">Executive Summary</h1>



<p>When two hospital systems merged, the Compliance function struggled to keep up with cumbersome exsiting processes. This was on top of another complex problem facing the hospital system: billing headaches.</p>



<p>The health system needed a better way to handle rejected and improperly coded bills, and in turn, improve overall revenue collection. And the Compliance function needed a system for verifying the right people were taking the right steps to accurately code bills.</p>



<p>Implementing YouCompli gave the Compliance function a reliable way to capture metrics, compile analytics, produce reports, and verify the rights steps were taken to comply. This elevated the Compliance function from the “department of no” to a strategic business partner.</p>



<h5 class="wp-block-heading">YouCompli empowered the Compliance function to verify the organization was doing what it needed to do to comply and deliver greater value.</h5>



<h1 class="wp-block-heading">The Challenge</h1>



<p>Merging two large health systems is a complicated and cumbersome process. As the organization tries to accommodate rapid growth, it can also face additional risk – including regulatory risk.</p>



<p>When an East Coast hospital system merged with a cross-town health system, the Compliance function struggled to keep up with merger challenges. This was on top of another complex problem facing the hospital system: billing headaches.</p>



<p>The health system needed a better way to handle rejected and improperly coded bills, and in turn, improve overall revenue collection. And the Compliance function needed a system for verifying the right people were taking the right steps to accurately code bills.</p>



<p>But the Compliance team only had access to software that was part workflow manager, part project manager. The software lacked regulatory analysis, model documents, and metrics.</p>



<p>The existing software package didn’t allow the Compliance function to thoroughly monitor regulations to be aware of relevant billing changes. And it didn’t help the Compliance function decide if billing changes were applicable, or manage the rollout and accountability of requirements. Nor did the software help verify the right steps were being taken and completed by required dates to comply.</p>



<p>The Compliance function needed one source to help with the whole process, from monitoring regulations to verifying it was taking the right steps to comply. That’s where YouCompli came in.</p>



<h1 class="wp-block-heading">The Solution</h1>



<p>Coding properly is, obviously, critical to a successfully run hospital system. When bills are coded incorrectly, the organization doesn’t get paid.</p>



<p>Part of the Compliance function’s role, of course, is ensuring that hospital systems are aware of the changing regulations that affect billing codes.</p>



<p>But what if there was another way for a Compliance function to support a hospital system’s billing process?</p>



<p>With YouCompli, there is. YouCompli tools enabled the hospital to connect its Revenue Cycle department’s account managers with its clinical delivery teams.</p>



<p>Specifically, the Revenue Cycle department used YouCompli tools to communicate with clinical delivery staff to verify they’re coding services correctly. Communicating before a service was provided proved critical to ensuring that everyone knew how to accurately code a bill.</p>



<p>This reduced miscoded services and inaccurate bills – leading to fewer claim rejections and payment delays.</p>



<p>YouCompli resources also helped the hospital system manage a new requirement related to prior authorizations for certain procedures. The Revenue Cycle got sufficient notice on a new prior authorization rule that they could communicate with patients about procedures scheduled before the requirement took effect, but that were subject to the prior authorization rule.</p>



<p>YouCompli enabled the Revenue Cycle department to verify prior authorizations for previously scheduled procedures. This ensured that the hospital system avoided denials for these procedures. Not only was this valuable in verifying compliance, it made a financial impact on the organization.</p>



<p>It’s another way the comprehensive YouCompli solution helped elevate the hospital system’s Compliance function.</p>



<h1 class="wp-block-heading">The Impact</h1>



<p>Healthcare compliance officers often have a tough time demonstrating their function’s value to the larger organization. YouCompli empowered this hospital system’s Compliance function to serve as a strategic business partner and demonstrate its value to business partners.</p>



<p>Before implementing YouCompli, the merged health system’s Compliance function had no idea how many new federal or state regulations were coming in. The compliance officer couldn’t be sure whether new or changing regulations even applied to the hospital system. Nor could the compliance officer verify whether the hospital system had complied with them.</p>



<p>Implementing YouCompli gave the Compliance function a reliable way to capture metrics, compile analytics, and produce reports. YouCompli armed the Compliance function with actionable data to inform hospital leaders of potential risks and other considerations.</p>



<p>This elevated the Compliance function to a strategic business partner, rather than a “department of no.” YouCompli enabled the compliance officer to provide hospital leaders with a complete view of the audit trail, tasks, business requirements, tools, and decision criteria. These resources empowered the Compliance function to better inform colleagues and leaders about the entire regulatory landscape.</p>



<p>The Compliance function also relied on YouCompli to monitor changes – billing-related and otherwise – coming in and verify which people were responsible for demonstrating compliance. YouCompli made it easy to verify completion dates for deliverables and prove how the organization has complied with a change.</p>



<p>And as the hospital system improved its handling of rejected and improperly coded bills, YouCompli helped verify the organization did what was required to comply. Centralizing all compliance resources in one place on YouCompli provided the hospital system with a comprehensive approach to managing regulatory change.</p>



<p>YouCompli gave the Compliance function confidence to serve as a business partner, knowing the right people were informed of relevant regulatory changes. Being able to verify progress and completion by required dates – for billing purposes and other regulations – was crucial to proving the Compliance function’s value. YouCompli provided a powerful way for the Compliance function to deliver greater value to the hospital system.</p>



<h6 class="wp-block-heading"><strong><a href="https://youcompli.com/blog/verify-show-what-steps-your-organization-has-taken-to-comply/" title="Find out how you can use YouCompli to verify">Find out how you can use YouCompli to verify</a> your organization has made best efforts to respond to regulatory changes appropriately. </strong></h6>



<h6 class="wp-block-heading"><strong>YouCompli customers have access to notifications about changes to regulations, resources to inform policy and procedure updates, and tools to track compliance.</strong></h6>



<div class="wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex">
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<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date' data-link='https://youcompli.com/blog/case-study/compliance-a-trusted-business-partner-verify-healthcare-compliance/' data-summary='Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date' data-app-id-name='category_below_content'></div><div style='display:none;' class='shareaholic-canvas' data-app='recommendations' data-title='Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date' data-link='https://youcompli.com/blog/case-study/compliance-a-trusted-business-partner-verify-healthcare-compliance/' data-summary='Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date' data-app-id-name='category_below_content'></div><p>The post <a href="https://youcompli.com/blog/case-study/compliance-a-trusted-business-partner-verify-healthcare-compliance/">Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></content:encoded>
					
		
		
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		<title>No Surprises Act: Prepare for greater transparency in 2022</title>
		<link>https://youcompli.com/blog/case-study/no-surprises-act-prepare-for-transparency-in-2022/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=no-surprises-act-prepare-for-transparency-in-2022</link>
		
		<dc:creator><![CDATA[Jerry Shafran]]></dc:creator>
		<pubDate>Thu, 18 Nov 2021 00:21:19 +0000</pubDate>
				<category><![CDATA[Case Study]]></category>
		<category><![CDATA[Rules and Regulations]]></category>
		<guid isPermaLink="false">https://youcompli.com/?p=5065</guid>

					<description><![CDATA[<p>The No Surprises Act is intended to increase transparency in healthcare and reduce unexpected bills for patients.</p>
<p>The post <a href="https://youcompli.com/blog/case-study/no-surprises-act-prepare-for-transparency-in-2022/">No Surprises Act: Prepare for greater transparency in 2022</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></description>
										<content:encoded><![CDATA[<div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='No Surprises Act: Prepare for greater transparency in 2022' data-link='https://youcompli.com/blog/case-study/no-surprises-act-prepare-for-transparency-in-2022/' data-summary='The No Surprises Act is intended to increase transparency in healthcare and reduce unexpected bills for patients.' data-app-id-name='category_above_content'></div>
<p>It’s a complicated law that aims to simplify.&nbsp;The No Surprises Act&nbsp;is&nbsp;intended to&nbsp;increase transparency in healthcare&nbsp;and lead to fewer unexpected bills for patients.&nbsp;</p>



<p>Congress passed the No Surprises Act at the end of 2020&nbsp;with bipartisan support&nbsp;as part of the Consolidated Provisions Act of 2021. Most of the law’s provisions will take effect on Jan. 1, 2022.&nbsp;</p>



<h2 class="wp-block-heading">Purpose&nbsp;of the&nbsp;No Surprises Act&nbsp;&nbsp;&nbsp;&nbsp;</h2>



<p>Surprise billing&nbsp;laws&nbsp;in most states&nbsp;apply only to insurance plans regulated by their respective state departments of insurance. They&nbsp;don’t touch self-funded, or&nbsp;Employee Retirement Income Security Act (ERISA),&nbsp;plans. The No Surprises Act closes that gap.&nbsp;&nbsp;</p>



<p>As&nbsp;<a href="https://www.linkedin.com/in/henry-casale-1a779429/" target="_blank" rel="noreferrer noopener">Henry Casale</a>, partner at Horty Springer, explains: “The No Surprises Act applies when a patient who is seeking care at a hospital that participates in a patient’s health program receives treatment (emergency and/or non-emergency) from a non-participating physician. When this occurs, and absent notice and consent, the non-participating physician’s claims for services rendered must be in accordance with what is allowable under the No Surprises Act and its regulations. For hospitals, this new obligation places a premium on, and generates an incentive to get as many providers on the hospital’s medical staff as possible to participate in the same insurance programs as the hospital.”&nbsp;</p>



<p>The Departments of Health and Human Services&nbsp;(HHS), Labor, and Treasury&nbsp;issued&nbsp;an&nbsp;<a href="https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule-to-protect-consumers-from-surprise-medical-bills.html" target="_blank" rel="noreferrer noopener">interim&nbsp;final&nbsp;rule</a>&nbsp;providing details on several aspects of the law.&nbsp;While a&nbsp;delay&nbsp;on enforcing&nbsp;certain&nbsp;provisions&nbsp;has been announced&nbsp;as&nbsp;the departments&nbsp;continue&nbsp;working&nbsp;on additional rules,&nbsp;there are measures your organization&nbsp;can&nbsp;take&nbsp;now to prepare.&nbsp;</p>



<h2 class="wp-block-heading">Identify the right internal players&nbsp;</h2>



<p><a href="https://www.hortyspringer.com/faculty/mary-paterni/" target="_blank" rel="noreferrer noopener">Mary Paterni</a>, associate attorney&nbsp;at Horty Springer,&nbsp;recommends&nbsp;beginning&nbsp;a&nbsp;compliance assessment by reviewing&nbsp;your&nbsp;hospital’s agreements with each of its physicians and physician groups.&nbsp;She notes, however, that most hospitals don’t have agreements with all the physicians appointed to their medical staff,&nbsp;which means the possibility for surprise bills will still exist.&nbsp;</p>



<p>“In anticipation of this, the surprise billing rules require each health care provider and facility to make publicly available, post on a public web site, and provide disclosure notice to each patient who is enrolled in a health plan and is treated at the hospital, information pertaining to the protections against balance billing provided by the No Surprises Act,”&nbsp;Paterni explains.&nbsp;&nbsp;</p>



<p>She&nbsp;recommends using the&nbsp;<a href="https://www.cms.gov/httpswwwcmsgovregulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10780" target="_blank" rel="noreferrer noopener">Model Disclosure Notice</a>&nbsp;published by&nbsp;the&nbsp;Centers for Medicare &amp; Medicaid Services&nbsp;(CMS).&nbsp;</p>



<p>Hospitals should prioritize areas that will be most affected by process changes, including registration and scheduling staff who will need to provide patients with a new form to sign. Billing and claims processing staff may need to add new language on billing statements around, for example, the process for disputing a bill.</p>



<h2 class="wp-block-heading">Develop No Surprises Act policies&nbsp;and educate&nbsp;</h2>



<p>It’s critical to have policies in place to demonstrate how you’ll comply with the new requirements.&nbsp;&nbsp;These policies need to&nbsp;keep&nbsp;in mind that these rules authorize HHS to impose civil monetary penalties against non-compliant providers.&nbsp;&nbsp;&nbsp;</p>



<p>Casale notes:&nbsp;“Compliance officers will need to stay on top of these regulations, be sure that the&nbsp;hospital is collecting the documentation that CMS wants to see in order to demonstrate compliance with the No Surprises Act, and in doing so, protect their hospitals from the threat of civil&nbsp;monetary&nbsp;penalties.”&nbsp;</p>



<p>Education&nbsp;and communications are&nbsp;also key. Develop scripts&nbsp;and FAQs&nbsp;for&nbsp;front-line&nbsp;staff who&nbsp;interact&nbsp;with patients.&nbsp;Also, ensure that&nbsp;leadership is&nbsp;aware of the upcoming changes.&nbsp;Your CEO should be up to speed on the&nbsp;new law&nbsp;and&nbsp;its implications for&nbsp;your organization. Likewise, your CFO should&nbsp;recognize&nbsp;the financial impact of the regulations and how they will impact billing, statements and required notices.&nbsp;</p>



<p>Testing and validation&nbsp;are crucial too.&nbsp;Verify that the forms are loaded into your system and that any notices required to be posted in the office are appropriately displayed.&nbsp;</p>



<p>For model procedures, policies,&nbsp;and expert tools specific to provisions of the No Surprises Act already in place,&nbsp;YouCompli&nbsp;offers&nbsp;practical tools to simplify compliance.&nbsp;</p>



<p>Begin your compliance assessment&nbsp;now&nbsp;to&nbsp;prepare&nbsp;for&nbsp;providing&nbsp;greater&nbsp;transparency&nbsp;in 2022.&nbsp;The fewer surprises in healthcare, the better.&nbsp;&nbsp;</p>



<p><em>How is your healthcare organization&nbsp;keeping up with new regulations&nbsp;like the No Surprises Act and other pending changes? Read more about&nbsp;our&nbsp;</em><a href="https://youcompli.com/intelligence/" target="_blank" rel="noreferrer noopener"><em>regulatory monitoring process</em></a><em>&nbsp;or&nbsp;</em><a href="https://youcompli.com/demo/" target="_blank" rel="noreferrer noopener"><em>schedule a demo</em></a><em>.</em>&nbsp;<br>Jerry Shafran is the founder of&nbsp;YouCompli.&nbsp;</p>



<h3 class="wp-block-heading">Subscribe to get the latest articles about healthcare regulatory changes.</h3>




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</div><div style='display:none;' class='shareaholic-canvas' data-app='share_buttons' data-title='No Surprises Act: Prepare for greater transparency in 2022' data-link='https://youcompli.com/blog/case-study/no-surprises-act-prepare-for-transparency-in-2022/' data-summary='The No Surprises Act is intended to increase transparency in healthcare and reduce unexpected bills for patients.' data-app-id-name='category_below_content'></div><div style='display:none;' class='shareaholic-canvas' data-app='recommendations' data-title='No Surprises Act: Prepare for greater transparency in 2022' data-link='https://youcompli.com/blog/case-study/no-surprises-act-prepare-for-transparency-in-2022/' data-summary='The No Surprises Act is intended to increase transparency in healthcare and reduce unexpected bills for patients.' data-app-id-name='category_below_content'></div><p>The post <a href="https://youcompli.com/blog/case-study/no-surprises-act-prepare-for-transparency-in-2022/">No Surprises Act: Prepare for greater transparency in 2022</a> first appeared on <a href="https://youcompli.com">YouCompli</a>.</p>]]></content:encoded>
					
		
		
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