Compliance = building the right process (not just digging up dirt)
Compliance Programs and Risk Assessments
What are the hallmarks of compliance effectiveness? It means a program that incorporates effective training, business process controls, operational compliance monitoring and delegate oversight sufficient to allow plans to know where they’re compliant or when they’re exposed to risk – and to routinely correct those deficiencies.
ATTAC Consulting Group’s compliance team aids organizations to conduct risk assessments, develop effective compliance systems and institutionalize controls at the foundation of each organizational process. Our solutions can help your organization implement programs that are essential to maintaining routine compliance.
Medicare Advantage, Part D and Medicaid Plans
Compliance requirements are ever expanding. ACG’s compliance team assists plans with:
- Compliance risk assessments
- Compliance program development
- Design and implementation of key monitoring metrics and audit programs
- Development of effective staff training programs
- Fraud, waste and abuse program development and implementation
- Beneficiary sales, EOC and ANOC material review
- Grievance and appeal program training
- Sales and marketing training and oversight
- First tier, downstream and related entity (FDR) delegate oversight
- Reporting and documentation of compliance action
- Data sourcing for development of compliance and operations metrics
- CTM process and resolutions
ATTAC supports accountable care organizations in implementing effective compliance programs that identify and mitigate risk. Our ACO compliance model focuses on:
- Risk identification
- Staff and provider training
- Data submission accuracy for beneficiary assignment and GPRO quality data
- Monitoring of opt-outs
- Beneficiary materials and marketing
- Data security, use of data and oversight of contractors
Qualified Health Plans (QHPs) and Exchange Compliance
Health Exchange and Qualified Health Plans exist in an environment of elevated government oversight. A strong compliance program is required to compete on the health exchanges and is key to financial and operational success.
ATTAC has the broad experience to implement government-regulated programs, and can support QHPs in developing and implementing key compliance and monitoring processes for the complex QHP environment.