Since every Compliance Strategies consultant has come to the team with practical experience in and in-depth knowledge of specific health care operations, it’s no surprise that clients continually ask for our assistance by delegating specific operational functions to our consultants.
We’ve also encountered clients who are looking to delegate functions simply because the task doesn’t warrant a full-time employee, or because they are looking to supplement their staffing. Depending on the size of your company and current bandwidth, it may be more cost-effective to have Compliance Strategies perform some functions.
Clients have delegated us to manage the material submission process; reviewing all materials so that they comply with regulatory requirements, managing the material submission and approval process, and ensuring the final draft is retained and compliant.
Clients have looked to us to assist with grievances and appeals functions. The scope of delegation ranges from having a consultant review draft member notices prior to distribution to having a consultant generate member notices based on case documentation.
Clients have asked for our assistance in supporting the compliance department. Tasks range from assisting with performing an annual risk assessment and conducting audits to evaluating allegations and completing compliance investigations.
Clients challenged with case-management functions have asked for our assistance in several areas including: developing case management department infrastructures; building care management systems; and creating compliant health risk assessments
Clients have asked for our assistance in partnering with their Utilization Management (UM) leadership teams to ensure compliance across all UM-related processes. Our role includes evaluating UM workflows, identifying regulatory risks, and ensuring that policies and procedures align with federal, state, and accreditation requirements.
Clients have looked to us to evaluate potential delegates to assess their ability to manage and perform the delegated function(s) in accordance with state and federal laws, rules, regulations, NCQA accreditation standards, and client policies and procedures.
