Compliance Program Implementation, Assessment & Support

All covered healthcare entities are required to develop and implement a compliance program as a condition of enrollment in Medicare, Medicaid, and the Children’s Health Insurance Program. Additionally, the Office of Inspector General (OIG), Department of Justice, and other federal and state agencies see a compliance program as the minimum standard a healthcare entity should maintain.

Services

Key components of a high-quality compliance program include detection and prevention of inappropriate conduct, as well as commitment to the organization’s legal and ethical values. These components are detailed in the Federal Sentencing Guidelines’ Seven Elements of an Effective Compliance Program.

A successful compliance program is the result of a combination of clinical and regulatory expertise. PYA offers a number of services that help organizations identify and prioritize compliance risks:

Compliance Program Assessment, Risk Assessment, and Advisory

  • Assesses policies, procedures, and responsive measures to determine opportunities for improvement
  • Assists in implementation of risk assessment process to stratify risk based on impact and likelihood of occurrence
  • Provides compliance program advisory and compliance work plan supplementation

Compliance Program Work Plan Development, Project Management, and Implementation

  • Assists with work plan development according to identified risk areas

Compliance Education, Boot Camp Services, and Support

  • Conducts two-day healthcare compliance “boot camp” sessions, structured according to HHS and OIG guidance
  • Offers a “compliance officer track” to develop future compliance professionals
  • Conducts service line leader training (one-day or multi-day modular program) that covers: communication of pertinent legal, regulatory, and compliance requirements; updates to
    department staff; and reinforcement of organizational training

Virtual Compliance Program Assistance

  • Provides virtual compliance officers to assist with compliance program effectiveness, risk assessment, work plan development, reporting to board of trustees, program implementation assistance, and training

Experience

PYA’s compliance expertise addresses the wide-ranging scope of regulation requirements:

Acute Care

  • Ambulance
  • Antibiotic Stewardship
  • Clinical Documentation Improvement
  • Leadership Training
  • Inpatient/Outpatient Documentation and Coding

Care Management

  • Patient Safety
  • Quality Reporting
  • Risk Management
  • Utilization Management

Post-Acute Care

  • Durable Medical Equipment
  • Home Healthcare
  • Hospice
  • Inpatient Rehabilitation
  • Skilled Nursing Facilities

Regulatory Compliance

  • 340B
  • Corporate Integrity Agreements—Independent Review Organization Assistance
  • Governmental Response
  • Litigation Support
  • Organizational Risk Assessment
  • Patient Safety Organization

IT Advisory Services

  • HIPAA Privacy and Security
  • IT Management Services
  • IT Risk Management
  • Meaningful Use

Ambulatory Care

  • Ambulatory Clinical Documentation Improvement
  • Physician Compensation
  • Physician Contractual Relationships
  • Physician Practice Operations

Behavioral Health

  • Eating Disorders
  • Geriatric Psychiatry
  • Inpatient/Intensive Outpatient
  • Post-Traumatic Disorders
  • Substance Abuse

Revenue Cycle

  • Charge Description Master Review
  • Reimbursement
  • Revenue Cycle

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