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Risk Management & Compliance

Barber Enterprise Solutions - Risk Management Services

Organizations such as ours are literally being overwhelmed by auditing from a variety of regulatory agencies, including federal, state and local governments; the alphabet soup of contracted audits such as RAC, MAR, PERM, ZPICS, CMS, OIG; and private payers. Numerous audits and reviews often lead to duplication of effort, and may ultimately result in a return of paid claims and multiple fines.

Compliance planning is now required to ensure adherence with all applicable federal, state and local laws, rules and regulations, as well as with the program requirements of federal and state sponsored health plans, such as Medicare and Medicaid. In addition, since Congress passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the U.S. Department of Justice's Office of the Inspector General has been mandated to establish programs to detect health care fraud and abuse as well as to encourage the public to report it. Most importantly, HIPAA also broadened the definition of 'knowing and willful conduct' with regard to the civil provision of the Social Security Act to include acts of 'deliberate ignorance' by providers with respect to information and regulation.

Our risk management and compliance consulting services are designed to assist health and human services organizations in preventing fraud, waste and abuse and ensure legal compliance by having tools for maintaining records; demonstrate effective auditing, monitoring and auditing processes; and, provide guidance with policies and procedures.

Agencies will be positioned to:

A core component of an effective Compliance program includes education. Our team at Barber Enterprise Solutions is prepared to provide educational programs that support the mandated training for all employees, i.e. fraud, waste and abuse; HIPAA; whistle blower; false claims act; and programs that are more specific for your auditing staff.

We can create a flexible plan to manage your entire in-house compliance program or just specific elements of your plan such as internal auditing function, anonymous employee reporting hot line, or investigation of potential fraud, waste and abuse.

We can help you build an effective compliance program that mitigates risk through:

  1. Gap analysis (Is your current compliance program meeting the seven required elements of the Office of Inspector General?)
  2. Training and education of required mandated staff training
  3. Developing the essential Code of Conduct for your culture
  4. Maintaining an audit system that includes an annual plan to review all of your business lines

Our consultants have assisted behavioral health agencies in developing their corporate compliance plans, conducted compliance audits of key risk areas (including billing and claims payment, electronic health record documentation, and provider credentialing and contracting) and assisted agencies in developing corrective action plans.

All of our consultants are members of the National Healthcare Compliance Association (HCCA).

Barber Enterprise Solutions

Barber Enterprise Solutions, Inc. (BES) collaborates with agencies in the fields of Intellectual and Developmental Disabilities, Behavioral Health, and Autism as they strive to provide high quality, cost effective services.

BES will offer extensive experience and a success-oriented strategy to help agencies meet their mission and achieve their goals. See how BES can improve the health of your business.  

 

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