Christi Grimm, the Inspector General of HHS, gave a recent keynote address to compliance professionals. In it, she said, “Simply put, the financial incentives created by risk adjustment may be driving upcoding in the severity of diagnoses to garner additional payments.”
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If we want to improve our organizations’ compliance culture, then we need to interact with our healthcare leaders in a way that sells compliance without “selling” compliance.
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A “reframe, regroup, refocus” approach enables compliance teams to work with other departments to provide excellent patient-centered care.
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“By being aware of how your leaders think, you will uncover social determinants of compliance and understand their potential impact on the organization. You can then respond and assist accordingly, or remove barriers to successful compliance deliverables.”
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“It behooves all healthcare compliance professionals to be aware of the fraud, waste and abuse risks associated with telehealth services. This mode of delivery holds great promise. For it to fulfill that promise, non-compliance needs to be rooted out and corrected.”
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“The secret to my success in reinforcing the value of Compliance’s work comes from partnering with HR. Developing standard interview questions, building leadership competencies, and sticking your neck out to establish strong relationships across the organization are crucial to demonstrating how Compliance delivers value.” – Lisa Herota
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“My success in uncovering millions of dollars in unbilled services demonstrates how revenue protection is a tangible way Compliance delivers value to healthcare organizations. It also underscores how compliance professionals make an impact across the business through building relationships, shaping culture, preventing fines, and positioning Compliance as true partner.” – Maeve O’Neill
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From fostering a culture of accountability to providing robust training programs, this insightful piece offers practical steps to enhance compliance, reduce risks, and ensure patient safety. Discover how organizations can navigate the complex regulatory environment and cultivate a workforce committed to upholding the highest standards of compliance. Read the full article for a comprehensive roadmap to success in healthcare compliance.
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Due to their violations of patient rights, covered entities and business associates are now facing increasing enforcement actions. In a breach, both parties bear financial and reputational risk. Shawn DeGroot recommends proactive compliance officers prioritize their agreements based on risk, establish communication channels, and collaborate on risk analysis to protect their organization.
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