Regulatory Compliance Tools from Strategic Management Services March 27, 2012
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1 Streamlining Assessments with Regulatory Compliance Tools from Strategic Management Services March 27, 2012 Presented by: Scott Shepherd, SAI Global Compliance 360 GRC Software Suite Camella Boateng, Strategic Management Services
2 Regulatory Environment 2 Office of Audit Services (OAS) Focus on Payments Office of Investigations (OI) Criminal and Civil Referrals to DOJ State Initiatives Recovery Audit Contractors (RACs) The Tax Relief and Health Care Act of 2006 Medicaid id Integrity Contractors t (MICs) Deficit Reduction Act of 2005 Medicare Administrative Contractors Office of Counsel to IG (OCIG) (MACs) Focus on Anti-Kickback, k Quality Providers The Medicare Prescription Drug Improvement and Modernization Act of 2003 Office of Evaluation and Inspections (OEI) Focus on Policy and Systems Zone Program Integrity Contractors (ZPICs) HIPAA 1996 Medicaid Fraud Control Units (MFCUs) Medicaid Fraud Federal Initiatives (e.g., ARRA, PPACA) Quality Improvement Organizations (QIOs) Social Security Act of 1982
3 About Strategic Management Management Consulting Firm Specializing in Regulatory and Corporate Compliance Solutions Established in 1992 Founder & CEO: Richard Kusserow, Former Inspector General of HHS Program Expertise Corporate Compliance Program HIPAA Pi Privacy and Security Compliance Risk Management Medicare & Medicaid Anti kickback Statute, Stark, Health Care Business Relationships 3 Program Evaluation, Auditing, Data Analysis, Investigations, Program Planning & Implementation, Protocol Development, Research & Analysis
4 Strategic Management Services Offices Corporate Headquarters (Washington, DC Office) 5911 Kingstowne Village Parkway Suite 210 Alexandria, VA (703) Chicago Office 809 Ridge Road Suite 206, Mezzanine Floor Wilmette, IL (847) Satellite Offices Colorado, Maryland, New York, and North Carolina 4
5 Strategic Management Team Principals and Key Personnel Former Inspector Generals Former CMS Executives FBI Investigators Attorneys, Economists, and Regulatory Analysts Industry Experience Hospitals Long Term Care Health Plans Law Firms Others 5
6 Strategic Management Services Clients Our Clients (sample) 6
7 Strategic Management Services Claims Data Analysis Compliance Program Services Compliance Resource Center Hotline, Policies and Procedures, Compliance Training, Sanction Screening, and Survey HIPAA and HITECH Act Compliance Independent Review Organization 7 Outsourced Compliance Officer Litigation Support Managed Care Parts C and D Services Physician Arrangement Reviews Responding to Government Auditors Regulatory Analysis Risk Management
8 SAI Global Compliance 360 GRC Software Suite Strategic Management provides content for the following suites: Regulatory Audit for Hospitals HIPPA Privacy Assessment HIPAA Security Assessment 8
9 HIPAA and HITECH Act Compliance Services Strategic Management helps organizations with HIPAA compliance: Privacy & Security Gap Analysis HIPAA Policies and Procedures HIPAA Training Programs Business Associate Agreements HIPAA Audits and Risk Assessments Breach Notification & Encryption Measures Data Flow of PHI, Disclosures, and Authorization Disclosure Accounting Methods Meaningful Use Requirements 9
10 Compliance Risk Management Services 10 Step 1 Step 2 Step 3 Step 4 Risk Identification & Assessment Risk Control & Remediation Risk Area Monitoring & Auditing Risk Reporting & Communication
11 11 QUESTIONS Scott Shepherd, Senior Solutions Consultant Camella Boateng, MPH, Senior Associate
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