HEALTH CARE Compliance & engagement Solutions

MOCK COMPLIANCE AUDITS

OUR PRODUCTS

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. 

our 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:

  • ​Documentation & Audit Preparedness for CMS Audits
  • Investigation, Management, & Documentation of Compliance Issues and Privacy Concerns
  • Marketing Material Submission and Reviews
  • Website & Public Disclosure Oversight
  • CMS Liaison Responsibilities
  • Effective & Compliant Implementation of Operational Requirements including Training, Monitoring, Benefit Enhancements and Waivers

#raisingourlegacy

#wilemsrg

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.

  • DCE Compliance Training Modules
    • DCE Overview Training
    • DCE Fraud, Waste and Abuse Training
    • DCE Privacy Training
    • DCE Comprehensive Training (includes Overview, FWA, and Privacy in one module)
    • DCE Consumer Advocate Training
  • ACO Compliance Training Modules
    • ​ACO Overview Training
    • ACO Fraud, Waste and Abuse Training
    • ACO Privacy Training
    • ACO Comprehensive Training (includes Overview, FWA, and Privacy in one module)
    • ACO Data Use Agreement Custodian Training
  • Anonymous Compliance Reporting Tool – Individuals can report any compliance concerns regarding the organization or activities. The tool allows individuals to report anonymously or to provide contact information. Reports are then transmitted to the appropriate leaders within the ACO or DCE.

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

One-on-one compliance program education

Compliance Program CONSULTING

COMPLIANCE marketing Material review

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.  

Online compliance training & reporting - Www.wrgtraining.com

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.

RAISING OUR LEGACY.

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

OUR SERVICES