Compliance and Risk Adjustment: Designing Your Playbook

ArroHealth

03/20/2017

The dictionary defines compliance as “the act of complying; acquiescence.”
We look at compliance as doing our best and doing what is right on behalf of our clients whether in analytics, retrieval, coding, or whatever it may be. We are an extension of other team’s culture and philosophy.
We must first see the regulation, recognize the change or derivation from the previous guidelines or regulations, digest it operationally, pro-actively plan with it, communicate it, implement it, monitor it, and maintain it.
Compliance is not always easy because it means consistent vigilance in reading the regulations, talking with CMS, understanding their intent, considering what is operationally feasible at that moment due to a change in position, the process, or even the tone.

As an industry, we have evolved to a greater level of sophistication due to compliance and it is curbing our focus and tactics.

Your risk adjustment compliance playbook should include contracts and scope, HIPPA policies and notifications, data security, claims validation, reports, coding guidelines, vendor management, member and provider communications, and escalation processes.

Compliance is woven into our fabric and considered during every launch, project, and client dialogue.
Find out how ArroHealth can assist you with your risk adjustment compliance needs, contact us at info@arrohealth.com.