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Regulatory
Compliance and Regulatory - Case History
Situation:
A regional health system already had the internal resources in place to audit its operation and identify potential risk areas. However, growing demands on members of the internal audit team had left them unable to fully assess operational and patient care practices that had previously ensured the organization's ability to meet the requirements of regulatory compliance. They were surprised when faced with an extensive Medicare audit that was triggered by a call placed by an unhappy former employee. The organization required immediate outside assistance to develop and implement a plan of correction.
Strategies:
The Corridor Group was retained to analyze the areas in which non-compliance was identified and develop strategies to:
- Write a plan of correction based on the survey conditions not met.
- Identify organizational problems and inadequacies that led to non-compliance situations.
- Implement improvements that would ensure continued compliance in the areas identified in the audit.
Tactics:
The Corridor Group first conducted an in-depth analysis of the organization and its responsible personnel. This analysis revealed inadequate leadership, resulting from recent resignations of top management. A financial analysis and billing audit corroborated the findings of the Medicare audit and confirmed a billing error rate of 25%.
In response to the Medicare audit, TCG developed a plan to correct and implement billing, documentation and patient safety remedies. Part of this plan included extensive staff education to ensure long-term compliance with documentation and patient safety. In addition, TCG brought in a transitional management team to provide leadership and perform day-to-day management responsibilities. An executive search program, also put into place by TCG, successfully recruited the necessary personnel to fill open positions.
Results:
Through The Corridor Group's compliance and regulatory consulting services, the desired results were achieved, including:
- Successful remedy of all non-compliance issues identified in the Medicare audit.
- Reduction of billing errors from 25% to less than 5%.
- An 85% improvement in documenting skilled reimbursable services.
- Successful placement of top-level management personnel.
In addition, The Corridor Group enabled the health system to maintain a positive cash flow that ensured their long-term viability.