When it comes to clinical compliance I'm going to look at it from the policy and procedure point of view. As a compliance professional you do not have to be clinical to make sure it gets done. You have to make sure your clinical group gets it done. Your clinical group really has the ownership of the materials and policies. They need to recognize the fact these need to get reviewed and updated at least on a yearly basis. As a compliance officer your job is make sure they do theirs. Nobody really wants to get hounded to do things but sometimes you do need to explain why it is important to do things in a timely manner. Like the Aviation field health care is going to get the same level of scrutiny as that field does. Once you accept that fact as an organization you will be much better prepared. What does need to get reviewed on at least an annual basis? Anything clinical that can change on at least a yearly basis. Sounds pretty broad doesn't it? Well it is, and the reason it is you should never assume anything. For example let say you do health coaching for diabetes as a company. You'll need to review what you coach on. That means you'll need to review changes in diabetes care, changes in diabetes medication, changes in diabetes health, fitness programs for diabetes, etc, etc. This might be a pain but as a health organization you have to do this. URAC and NCQA expect this, so do the feds and the state folks also. Besides isn't it best practice to review these items anyways?
Compliance isn't about making people miserable internally, compliance should really be about making people externally healthier by making sure you provide the best care possible.
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Imported/Syndicated Blog Original Publish Date : Tue, Jun 12, 2012