HEALTH CARE Compliance & engagement Solutions

Compliance Program creation

OUR Compliance Solutions 

Online compliance training & reporting

We'll review and provide recommendations for your marketing materials and implementation plans based on our experience with CMS/CMMI guidelines and regulations for communication with the public, physicians, and beneficiaries. We can help ensure that your materials:

  • Meet the regulatory and sub-regulatory requirements released by CMS/CMMI

  • Are approved by CMS/CMMI as necessary

  • Accurately portray the elements of the program or model

The Wilems Resource Group web-based platform allows your ACO to effortlessly implement two of the five Compliance Program Requirements: a method for anonymous reporting and annual compliance training.  

  • Compliance Training Modules – ACO related individuals are able to access the self-guided training (i.e. Compliance; Fraud, Waste and Abuse; Privacy; DUA Custodian; Consumer Advocate). Upon completion of a training, the individual submits a brief attestation to confirm their understanding of the material. Completion reports are generated and shared monthly with leadership.
  • Anonymous Reporting Tool – Individuals can report any compliance concerns regarding the ACO or organizational activities. The tool allows individuals to report anonymously or to provide contact information. Reports are then transmitted to the appropriate leaders within the organization.

Monitoring & Audits

We'll conduct an internal audit or help you respond to an external audit such as a Next Generation IRR or REACH ACO Participant & Preferred Providers Audit. We'll review your existing Compliance Programs to identify any gaps or areas with deficiencies. An internal audit and monitoring program can help ensure you are meeting regulatory requirements and prepare you from an audit request from CMS/CMMI. During the audit, we will identify potential areas for improvement and work with your organization to remediate the issues. This service includes the review of: 

  • Tracking Systems (as listed previously)

  • Policy & Procedures 

  • Training Materials

  • Compliance Reporting & Investigations

  • Monitoring & Oversight Program

RAISING OUR LEGACY.

#raisingourlegacy

#wilemsrg

Compliance isn't about jumping through regulatory hoops, it's about doing what's right to protect the beneficiary. Our industry has turned toward patient-centered care and at Wilems Resource Group, we believe in patient-centered compliance. This means we implement regulatory requirements with a constant focus on what our efforts mean for your beneficiaries. 


We have helped ACOs and DCEs across the country remain compliant and be successful within the Medicare Shared Savings Program, Next Generation ACO Model, Global & Professional Direct Contracting (GPDC) Model, and now the ACO REACH Model. Our clients receive more than compliance-minded solutions, but solutions that are grounded in our leadership's extensive experience in operations, compliance, and engagement. We have been in the trenches and understand the complexities of creating effective compliance programs. Our goal is to remove burdens and challenges your organization may face related to compliance requirements, and help you build or refine a program that aligns with your organization's overall strategy and culture. 

We'll develop a Compliance Program to meet the needs of your organization and the requirements of the Shared Savings Program or the ACO REACH Model. If you already have particular elements in place, we can work to build on what you have started. This service includes the creation and implementation of policies & procedures, a monitoring program, training materials and tracking systems for:

  • Privacy Requirements

  • Participant and Preferred Provider Additions & Deletions Process

  • Documentation of Benefit Enhancements​

  • Policy & Procedures Review Processes

  • Utilization of Fraud, Waste & Abuse Waivers

  • CMS/CMMI Notifications & Guidance Follow-Up

  • Compliance Reporting & Investigations

  • Marketing Material Review Processes

  • Compliance Training Completion

  • Access Management for CMS Systems

our COMPLIANCE EXPERTISE 

marketing Material review