Be a Compliance Champion
Government-sponsored health plans are challenged every day with changing rules and regulations from both the state and federal government. These rules can number in the thousands. And when only a handful are relevant, the task of vetting these rules is daunting – especially when CMS issues weekly, sometimes daily, change notices.
Compliance directors are responsible for ensuring materials meet regulatory compliance. Failure to do so could have serious consequences: incurring exorbitant expenses to correct erroneous material, or even facing the risk of being shut down for falling out of CMS’s good graces.
With Our Compliance Consulting Services, You Achieve:
- Better collaboration between departments. We evaluate, plan and implement workflow and process improvements to ensure the compliance and marketing communications departments work together.
- Quick and easy tracking and reporting on compliance issues. The Regulatory Analyzer® by CodySoft® provides one location to easily search for relevant CMS and state rules and regulations. And when integrated with the Collateral Management Module®, the Regulatory Analyzer® reports regulatory rules relevant to every piece of collateral material in production.
- Improved risk management. We conduct a compliance audit to identify areas of risk and provide a risk assessment to mitigate potential issues.
- We develop and implement…
- Operational and compliance workflows and policy documents
- Policies and procedures required by federal regulatory agencies
- Policies and procedures to meet Medicaid contract requirements
- Code of Ethics and Standard of Conduct documents
- We develop compliance organization strategy, design, and infrastructure. And we recruit experienced compliance leaders and staff.
- We design compliance training and education programs.
- We develop…
- Protocols and tools that track and convey internal compliance communications
- Workflow designs to intake, disseminate, track and manage regulatory communications-including HPMS memos
- We conduct…
- Compliance program risk assessments and ongoing monitoring of compliance risks
- Compliance audits and CMS mock audits to ensure CMS standards are met
- Risk assessments and audits to Medicaid contracts
- Operational department audits to ensure compliance standards are met
- Delegated vendor audits against contractual requirements
- We also design corrective action plans.
- We evaluate sales and marketing operational effectiveness, including sales agent oversight. And, we design formal disciplinary standards and incident management processes.
- We also conduct…
- Compliance investigations of suspected violations of corporate policy, contracts, rules and regulations
- Evaluations of suspected marketing regulation violations, including CMS and CTMs
- General corporate investigations and training