EXAMINING THE FOUNDATIONAL FEATURES OF A PATIENT PROTECTION-DRIVEN COMPLIANCE PROGRAM
When taking a closer look at the components that serve a patient protection-driven compliance program, there are three key factors that drive compliance: The regulatory scheme, standard-setting organizations and best practices.
HCCA is host to a panel discussion during its annual Compliance Institute featuring Valerie Mondelli, Chief Revenue Officer for Verisys Corporation as moderator, and panelists Beverly Craig, RN, Vice President of Regulatory Compliance and Clinical Risk Management; Herman Williams, former Chief Clinical Officer; Jennifer Gillespie, Compliance Officer for Verisys.
Beverly Craig comes from the clinical side as an RN and has deep expertise on the regulatory compliance and clinical risk management side; Herman Williams specializes in public health and policy issues; Jennifer Gillespie brings expertise with requirements on the regulatory framework and standards side.
Valerie Mondelli, RPh, MBA, has vast experience in health care technology across every market and is a passionate advocate for transparency in health care using data and technology platforms. Under her guidance the panel experts will discuss the evolution of compliance as a career path, how provider transparency is the first step to patient safety, how new regulations and health care delivery methods affect the role of compliance, and the importance of a solid compliance program on the mitigation of fraud, waste and abuse.
“People are vulnerable,” says Beverly, “we are data rich, but it doesn’t necessarily help us get down the path. When a patient starts with a medical doctor, then gets referred to a surgeon, then the patient develops an infection and gets referred back to the medical doctor—at some point you have to be able to attribute the infection to a specific procedure and practitioner.” Outcomes have become the metric that determines reimbursement and it’s important to track the correlation between quality outcomes and quality providers that are cultivated and sustained through rigorous enforcement to a patient protection-driven compliance program.
Herman explains that an excluded provider may not cause harm to a patient directly, but there could be financial impact if fines and monetary penalties are levied. When infractions to federal regulations occur and an organization enters into a Corporate Integrity Agreement (CIA), time, resources and energy are diverted to satisfy the CIA requirements—all at a great cost to the organization.
A best practices approach bundles the “Have To” of federal requirements, the “Agreed To” adherence to applicable standards, and “Individual Excellence” of going above and beyond. This combination assures use of the best data and technology that consolidates across all departments the applicable records used to screen, verify and continuously monitor for the credentialing of licensed providers as well as all staff members within an organization.
|Written by Juliette Willard
Healthcare Communications Specialist
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