shutterstock_770784181 SS.jpg

Enterprise Compliance Program Effectiveness Review

What is the status of your compliance program’s effectiveness? Is it running on all cylinders? Have you evaluated organizational risk, prioritized audits and work plans based on an enterprise risk assessment? Are the “seven essential elements” for an effective program known throughout the organization? Is everyone focused on quality, cost, efficiency and compliance? Have you had an independent review in the past eighteen months?

No program is without gaps, in fact, the biggest red flag is a perfect self-assessment! Furnace Brook Advisors can uncover hidden gaps and help your organization understand the risk, cost, and speed time to completion. Most importantly, our technology partner ComplyAssistant, powers a secure, cloud based, enterprise wide tracking and project management tool enabling Board, Administration, and Managers 24 / 7 / 365 access to their program.

Imagine a comprehensive program residing on a platform designed to meet the specific compliance needs of your organization. No more spreadsheets or wasted time looking for policies and procedure binders. Eliminate last minute preparations for committee meetings or compiling reports to the board!

Furnace Brook HealthCare Management Advisors can bring organization, access, and accountability to critical information – reassuring you exactly where the organization’s program stands!

We can conduct or support focused reviews and/or assist with creating:

  • Risk Assessments / Self-Assessments / Work Plans

  • Policies & Procedures

  • Arrangements / Code of Ethics / Conflict of Interest

  • HIPAA / Privacy / HITECH / HITRUST

  • Business Associate Agreement Management and Vendor Audits

  • Executive, Physician, Staff Training

Corporate Integrity Agreement (CIA) Requirements Compliance

Some organizations face the need to enter into CIAs with the Office of the Inspector General (OIG) and agree to specific conditions as a result. Many of these agreements stipulate that an Independent Review Organization (IRO) be engaged to assure compliance the agreement terms. The designation of an IRO must typically be made within 90 days of the agreement’s execution.

The first visit for an IRO occurs approximately one year later to initiate an “independent review”. Don’t expect advice! These organizations need to remain independent and provide an accurate assessment of progress and compliance to the OIG.

Don’t risk falling behind! Our team can design and provide a customized framework for organizations to operate within guidelines set by the CIA, and monitor requirements accountability with the agreement on a 24 / 7 / 365 basis. Our commitment is to provide the necessary tools, documentation, guidance, and support to assure conditions of the agreement are being complied with. We accomplish this with quarterly reviews and our technology solution powered by ComplyAssistant.

Clinical Documentation Management Audits and Medical Necessity Reviews and support

According to Modern Healthcare, it is estimated that nearly $262 billions of claims submitted by providers are initially rejected annually. While there are many reasons given, some technical and workflow related, many denials are due to clinical documentation not making a case for the medical necessity of treatment or procedures rendered. We can help physicians become proficient in creating an accurate, as well as accepted, clinical picture of the patient condition and the services needed to address them.

We firmly believe that clinicians want what is best for their patient, our approach is to work collegially with physicians, practitioners, staff and invested technology with professional peers “who have walked in their shoes”. Our team focuses on the integrity of the clinical documentation, its relationship to the quality of the service(s) provided which in turn will drive financial and compliance excellence.

We can help identify and solve patterns and process for denials due to insufficient documentation, timeliness in filing, lack of prior authorizations and eligibility.