Proactive Healthcare Compliance and the Importance of Continuous Monitoring

Proactive healthcare compliance refers to an approach where an organization seeks to identify and address compliance risks before they become a problem. This approach can have several benefits, including: 

1. Mitigating legal and financial risks: By identifying and addressing compliance risks proactively, organizations can reduce the likelihood of legal and financial penalties associated with non-compliance. 

2. Improving reputation and trust: Proactive compliance can help organizations demonstrate their commitment to ethical behavior, which can enhance their reputation and build trust with stakeholders. 

3. Enhancing operational efficiency: Proactive compliance can help organizations identify inefficiencies and opportunities for improvement, which can enhance operational efficiency and reduce costs. 

4. Enabling innovation: By proactively identifying and addressing compliance risks, organizations can create an environment that encourages innovation and creativity, without compromising compliance. 

5. Promoting a culture of compliance: Proactive compliance can help promote a culture of compliance within the organization, where employees understand and prioritize compliance, and actively seek to identify and address compliance risks. 

6. Facilitating strategic decision-making: Proactive compliance can provide organizations with a better understanding of the compliance risks associated with various strategic decisions, allowing them to make more informed decisions that consider compliance implications. 

Overall, proactive compliance can help health plans manage compliance risks more effectively, while promoting a culture of compliance, enhancing operational efficiency, and enabling innovation. By adopting a proactive approach to compliance, organizations can position themselves for long-term success, while minimizing legal and financial risks associated with non-compliance. 

So, what are the key steps to achieve a Proactive Compliance program? 

First: Continuous Monitoring of your Program Audit Universes 

An audit universe is a comprehensive list of all the business processes, functions, and units within an organization that require audit attention. Continuous monitoring of audit universes involves regularly reviewing and updating the audit universe to reflect changes in the organization’s structure, risks, and business environment. Here are some benefits of continuously monitoring audit universes: 

1. Helps in identifying emerging risks: Continuous monitoring of audit universes can help in identifying new risks as they emerge. This helps the organization stay proactive in mitigating these risks and prevents them from turning into major issues. 

2. Enhances audit planning: Continuous monitoring of audit universes can help in identifying areas of the organization that require increased audit attention. This information can be used to prioritize the audit plan and allocate resources accordingly. 

3. Improves risk management: By keeping the audit universe up-to-date, the organization can identify and assess risks more effectively, which can lead to improved risk management. 

4. Facilitates compliance: Continuous monitoring of audit universes can help in identifying compliance requirements that the organization must meet. This helps the organization stay compliant with relevant laws and regulations. 

5. Supports decision-making: A well-maintained audit universe provides a comprehensive view of the organization, which can be used by senior management and the board of directors to make informed decisions. 

Overall, continuously monitoring audit universes helps in maintaining an effective and efficient audit function, improving risk management, and supporting decision-making. 

Second: Practice, Practice, Practice.  Regular Internal Mock Audits are an essential part of the healthcare compliance process. 

Mock audits are simulated internal audits that are conducted to assess an organization’s readiness for an actual audit. Regular mock audits can be beneficial for several reasons: 

1. Identifying gaps in compliance: Mock audits can help identify gaps in compliance with relevant laws, regulations, and industry standards. Identifying these gaps can help the healthcare organization take corrective action before an actual audit. 

2. Assessing the effectiveness of controls: Mock audits can help assess the effectiveness of the organization’s internal controls. This helps in identifying weaknesses and areas for improvement, which can be addressed before an actual audit. 

3. Building staff confidence: Mock audits can help build the confidence of staff who will be involved in an actual audit. This can help reduce anxiety and stress associated with audits and can help ensure that staff are prepared to answer questions and provide necessary documentation. 

4. Improving communication and collaboration: Mock audits can help improve communication and collaboration between different departments within the organization. This can help ensure that all necessary information is available to auditors and can help improve the overall audit process. 

5. Enhancing risk management: Mock audits can help identify potential risks that may not have been previously identified. This can help the organization take necessary steps to mitigate those risks before they become a problem. 

Overall, regular mock audits can help organizations identify areas of weakness, improve compliance, and reduce the likelihood of surprises during an actual audit. By conducting regular mock audits, organizations can ensure that they are prepared for an actual audit and can demonstrate their commitment to good governance, risk management, and compliance. 

Third: Automate the areas that you can. 

Automation can play an important role in audit preparation, making the process more efficient, accurate, and effective. Here are some ways that automation can be used in audit preparation: 

1. Data extraction and analysis: Automation can help extract data from various systems and sources, allowing auditors to analyze data quickly and accurately. This can help auditors identify potential risks and areas for further investigation. 

2. Sampling and testing: Automation can be used to select and test samples, reducing the time and effort required for manual sampling and testing. This can help auditors focus on areas of higher risk and provide more assurance in a shorter time frame. 

3. Document management: Automation can be used to manage and organize audit documents, making it easier to track and review documentation throughout the audit process. 

4. Communication and collaboration: Automation can facilitate communication and collaboration between auditors and clients, making it easier to exchange information and documentation, and to track progress and feedback. 

5. Report generation: Automation can be used to generate audit reports, reducing the time and effort required for manual report generation. This can help ensure that audit reports are accurate, complete, and timely. 

Overall, automation can help auditors prepare for audits more efficiently, accurately, and effectively. By using automation in audit preparation, auditors can focus on higher-value activities, such as risk assessment and analysis, and provide greater assurance to clients. 

In summary, continuous monitoring of CMS universes can help maintain an effective audit function, improve risk management, and support decision-making. Regular mock audits can identify weaknesses, improve compliance, and reduce surprises during an actual audit. Automation can help auditors prepare for audits more efficiently and accurately, enabling them to focus on higher-value activities, such as risk assessment and analysis, and provide greater assurance to clients. Overall, mock audits and automation can help organizations prepare for actual audits and demonstrate their commitment to good governance, risk management, and compliance. 
 
If you have any questions, or you’d like to discuss  with one of our compliance experts, please call us at 1.408.850.2235. or Contact Us.