COMPLIANCE PROGRAM CREATION
We'll utilize existing elements and build a program that works with the operational activities currently in place at the ACO/DCE. This service includes the creation and implementation of policies & procedures and a quarterly monitoring program.
COMPLIANCE PROGRAM REVIEW
We'll review documentation of ACO/DCE governance structure and any current compliance activities in place at the organization. The review will focus on the identification of operational gaps and determine if the ACO/DCE documentation is sufficient to meet minimum regulatory requirements. The Findings & Improvement Report details the outcomes and identifies opportunities for improvement in the Compliance Program. Our team will work with the ACO/DCE to close identified gaps either through a hands-off (Corrective Action Review) or hands-on (Corrective Action Implementation) approach.
We'll conduct a mock audit that mimics a CMS audit of the required program elements. The following are examples of mock audits available: Compliance Program, Voluntary Alignment, Beneficiary Notification, Roster Management, Contracting & Provider Notification Process, Benefit Enhancements.
COMPLIANCE PROGRAM MANAGEMENT
We'll provide compliance oversight and management services for the ACO/DCE. Our team can report to a named Compliance Officer or serve as the Compliance Officer and team, depending on the needs of your organization. The day-to-day activities of the Compliance Team can be difficult to foresee, it may include but is not limited to:
We'll help your ACO or DCE effortlessly implement two of the five Compliance Program Requirements: a method for anonymous reporting and annual compliance training. The Wilems Resource Group web-based platform allows individuals to complete compliance training or make a compliance report anytime from anywhere. Modules can be purchased separately based on your organization's needs. Upon completion of a training module, the individual submits a brief attestation to confirm their understanding of the material. Completion reports are generated and shared monthly with ACO leadership.
Kimberly and the WRG team have provided a professional, well-rounded and comprehensive compliance program to our ACO. Navigating the complex landscape of compliance in population health is daunting, but we feel in good hands with the WRG team.
Tyler Wilson, Piedmont Community Health Collaborative
Your organization has committed to providing high-quality, coordinated health care through participation in the Global & Professional Direct Contracting Model or a Commercial, Medicare Shared Savings Program, or REACH ACO. Our main goal at Wilems Resource Group is to remove burdens and challenges your organization may face related to compliance requirements and engagement programs. We understand that your team needs to focus on the most important aspect of health care...the beneficiary.
At Wilems Resource Group, we measure success on our ability to help you understand program requirements, determine the appropriate level of acceptable compliance risk, and create programming that meets all regulatory requirements. Wilems Resource Group has helped organizations all across the country remain compliant and be successful within Medicare value-based care models and programs. We first take the time to understand your company culture and business goals. We listen and learn from you. Working alongside your team, we build customized compliance and engagement programs for your organization, physicians, practice managers, and beneficiaries.
We'll develop and delivery a customized 1.5-hour training to educate your ACO/DCE Leadership on compliance program requirements, operational considerations, audit preparedness, best practices, and CMS red flag issues.
We'll review and provide recommendations for your marketing materials 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 Shared Savings Program, GPDC Model, or ACO REACH Model
WILEMS RESOURCE GROUP
HEALTH CARE Compliance & engagement Solutions