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Month: December 2023

Checklist for Excellence: 7 Key Elements for an Effective Health Plan Compliance Program

In the intricate realm of healthcare, navigating compliance requirements is essential for health plans aiming to succeed amidst evolving regulations. A well-crafted corporate compliance program is not merely a risk-mitigation strategy; it serves as a cornerstone for building a reputable brand, fostering stakeholder trust, and ultimately achieving success.

This blog offers a straightforward checklist, guided by the Seven Fundamental Elements of an Effective Compliance Program, a framework developed by the Health Care Fraud Prevention and Enforcement Action Team (HEAT)1, a joint HHS/DOJ initiative dedicated to safeguarding patient care and preventing healthcare fraud.

Embrace these seven key elements to confidently update or build a robust compliance program and ensure your healthcare organization thrives:

1. Implement Written Policies, Procedures, & Standards of Conduct:

  • Clearly define your organization’s commitment to compliance with federal and state regulations.
  • Provide employees with guidance and standards of conduct for compliance-related issues.
  • Regularly review and update policies and procedures to reflect changes in regulations.

2. Designate Chief Compliance Officer, Corporate Compliance Committee & High-Level Oversight:

  • Appoint a Chief Compliance Officer (CCO) who is independent from business operations.
  • Establish a Corporate Compliance Committee with senior management and departmental representatives.
  • Ensure high-level oversight and commitment to the compliance program.

3. Conduct Effective Training & Education:

  • Develop and implement regular training programs for all employees and related entities.
  • Cover topics such as compliance, HIPAA, fraud, waste, and abuse prevention.
  • Update training materials annually and whenever regulations change.

4. Develop Strong Lines of Communication:

  • Foster an open and transparent communication environment.
  • Encourage employees to report suspected compliance violations without fear of retaliation.
  • Provide multiple channels for reporting, such as hotlines and anonymous reporting systems.

5. Enforce Well-Publicized Disciplinary Standards:

  • Clearly define disciplinary actions for non-compliance.
  • Apply disciplinary actions consistently and fairly.
  • Communicate disciplinary standards to all employees.

6. Conduct Routine Monitoring, Auditing, & Identification of Compliance Risks:

  • Conduct regular monitoring and auditing of operational activities.
  • Identify and assess potential compliance risks.
  • Develop and implement corrective action plans to address identified risks.

7. Create a System for Prompt Response to Compliance Issues:

  • Establish a process for investigating reported compliance violations.
  • Take appropriate disciplinary action, if necessary.
  • Implement corrective action plans to prevent future violations.

Unlock Compliance Confidence with HealthAxis

The journey towards impeccable healthcare compliance is intricate yet imperative. The seven fundamental elements serve as a blueprint for constructing a robust and effective compliance program, vital for any health plan striving to excel in the dynamic healthcare landscape. However, understanding that the path to compliance is complex and continuously evolving, HealthAxis stands as your steadfast ally.

HealthAxis stands out with specialized consulting services tailored to your unique needs. Our experts are dedicated to providing actionable strategies that ensure regulatory adherence and drive operational excellence. Let HealthAxis be your guide to navigating compliance challenges with confidence. Learn how our consulting services can transform your compliance approach into a strategic advantage.

Source:
1. Healthcare Compliance Tips, Office of Inspector General (OIG)

CMS Part C and Part D Program Audit Checklist: Be Prepared for Success

 

Health for All: Time for Action – Celebrating Universal Health Coverage Day

Every year on December 12th, the world unites in celebration of Universal Health Coverage Day (UHC Day). This official United Nations-designated day serves as a potent reminder of the critical need for strong, equitable, and resilient health systems accessible to all, regardless of background or financial means. It also marks the anniversary of a pivotal moment in global health history: the 2012 unanimous endorsement of UHC by the United Nations (UN) as a cornerstone of international development.

A Right, Not a Privilege: The Origins of UHC Day

The concept of UHC finds its roots in the 1946 World Health Organization (WHO) Constitution, which enshrines health as a fundamental human right and pledges to ensure the highest attainable level of health for all. UHC embodies the aspiration that everyone, everywhere, can access quality healthcare services when and where they need them, without facing financial hardship.

This vision has been further cemented by its inclusion as a key target in the United Nations Sustainable Development Goals (SDGs), specifically SDG 3.8: Achieve universal health coverage and access to essential healthcare services for all. UHC’s significance extends beyond healthcare, contributing to social inclusion, gender equality, poverty eradication, economic growth, and, ultimately, human dignity.

Time for Action: The 2023 UHC Day Theme

The theme for UHC Day 2023, Health for All: Time for Action, calls for immediate and tangible steps to get progress towards UHC back on track. Following the renewed global commitment to UHC at the UN High-Level Meeting on September 21st, 2023, it’s time to move beyond promises and into concrete action.

This means urging our leaders to enact policies that guarantee equitable access to essential health services, without financial barriers. It means ensuring good health and well-being are not a privilege for the few, but a right for all.

The urgency of action is amplified by the sobering reality that, according to the UN’s official page on UHC Day:

  • Half the world’s population still lacks access to essential health services.
  • 2 billion people face financial hardship due to out-of-pocket health expenses, including 344 million living in extreme poverty.
  • Since the launch of the SDGs in 2015, progress towards UHC has stalled, even before the COVID-19 pandemic.
  • The pandemic has further set countries back on their UHC journey, while also highlighting its crucial importance.

Building a Healthier Future: A Collective Call to Action

This UHC Day, let’s not just celebrate the vision; let’s commit to making it a reality. We can achieve this by:

  • Holding our leaders accountable for enacting UHC-aligned policies.
  • Supporting organizations working to strengthen health systems and promote access to healthcare.
  • Raising awareness about the importance of UHC and advocating for its implementation.
  • Sharing our own experiences and stories to amplify the call for health for all.

Remember, UHC is not just a goal; it’s a promise. By working together, across sectors and borders, we can build a future where everyone, everywhere, has the opportunity to live a healthy and fulfilling life.

To learn more and take action, visit the official UHC Day website: https://universalhealthcoverageday.org/