The Compliance Committee focuses on all aspects of corporate compliance & privacy activities required of healthcare organizations. The Committee is charged with exploring compliance program best practices, as well as advising the planning of the annual joint compliance and internal audit conference in December 2024 with the New England Healthcare Internal Auditors (NEHIA). The Committee is also responsible for organizing promotional content for the annual education session, including creating blog posts before and following the session, recruiting writers to prepare 2-3 additional blog posts for the chapter’s blog and general advancement activities aimed at enhancing and growing the chapter’s membership.
This year’s Compliance Committee is comprised of seven industry leaders:
* Chair / Board Liaison: Grace Jodhan / Dhara Satija
* Members: Wendy Chartrand, Nellie Goodman, Olga Gross-Balzano, Robyn Hoffmann, Audra Hulme
Meet the Committee!
Wendy Chartrand
Chief Compliance and Privacy Officer, UMass Memorial Health – HealthAlliance -Clinton Hospital and UMass Memorial Health – Marlborough Hospital
Question: What is the biggest industry challenge from the compliance and revenue integrity perspective?
Answer: Regulatory oversight poses challenges for both billing compliance and revenue cycle teams. Both struggle to gain access to all data across multiple systems with limited integration. Even when it is possible to access the data in various systems, organizations find that data alone is not enough to address the issues at hand. Data mining is necessary to gain meaningful information to identify risks and implement improvements.
Nellie Goodman
Enterprise Sales Director, MDaudit
Question: What is the biggest industry challenge from the compliance and revenue integrity perspective?
Answer: There are several challenges coming together for compliance and revenue integrity teams right now – commercial payers are using AI and other technologies to double down on denials and are taking much longer to pay claims in the first place, and both commercial and governmental payers have drastically increased the number of external audits being sent to provider organizations. On top of this, many compliance and revenue integrity departments are still functioning with significant staffing shortages while being asked to do more than ever before, may be siloed from each other, and using mostly manual processes for their auditing and denial mitigation efforts, which is resulting in major revenue leakage and more refunds to payers.
Olga Gross-Balzano
Senior Manager, BerryDunn
Question: What is the biggest industry challenge from the compliance and revenue integrity perspective?
Answer: There are certainly a few significant challenges that healthcare providers are concerned about. From my perspective, the expediential growth of Medicare Advantage plans is the most troublesome. The majority of providers are not prepared to deal with rapidly-changing number of plans with varying coverage, payment rules, and pre- or post-payment reviews. However, the most complex aspect of Medicare Advantage increase is related to ensuring timely and proper patient care access under business conditions where a prior authorization and confirmation of benefits may take prohibitively long time.
Audra Hulme
Director, PwC
Question: What is the biggest industry challenge from the compliance and revenue integrity perspective?
Answer: From a compliance and revenue integrity perspective, I’d say most organizations are struggling to keep pace with the increasing volume of payer-initiated audits, particularly as value-based reimbursement trends persist. Ensuring governance and transparency over this activity exists across the organization is half the battle, and establishing proactive monitoring over day to day to operations is critical so organizations have the chance to re-educate and correct.
Robyn Hoffmann
Senior Manager, Compliance and Credentialing, Berry Dunn
Question: What is the biggest industry challenge from the compliance and revenue integrity perspective?
Answer: Cybersecurity attacks have profound implications for healthcare organizations and for payers. Compliance and Revenue Cycle departments have important roles to play in the development of effective business and clinical continuity plans to safeguard the well-being of their patients and the healthcare organization itself.
Grace Jodhan
Executive Director, Compliance & Privacy Officer, Beth Israel Lahey Health
Question: What is the biggest industry challenge from the compliance and revenue integrity perspective?
Answer: The highest Compliance/Revenue Cycle risk can vary depending on the organization’s controls, services they provide, etc. However, I believe identifying inappropriate billing patterns and subsequently refunding overpayments in a timely manner consistently poses a challenge and requires strong collaboration between Compliance and Revenue Cycle teams.
Dhara Satija
Healthcare Consulting Leader, Paul Hastings, LLP
Question: What is the biggest industry challenge from the compliance and revenue integrity perspective?
Answer: The ever-changing regulatory landscape on top of the increased number of new entrants, including innovative healthcare delivery models / solutions, presents a continuous challenge for the health care industry. As healthcare organizations enter into a new venture and/or introduce a new line of healthcare business, it is important to evaluate new risk areas, operational practices, and understand the revenue flow to inform the organization’s proactive approach to compliance and risk management.
The Committee meets approximately 10-12 times a year, either in-person or by telephone. During these meetings, the Committee discusses current events and hot topics and prepares for the educational session, all while benefiting from shared knowledge and learning from across the industry. The committee collaborated to think outside the box to host various educational programs virtually and in-person for our members.
Upcoming events:
* Compliance Hot Topic Webinar July 2024 [More details coming soon]
* Annual HFMA MA-RI & NEHIA joint compliance and internal audit conference December 4-6, 2024
Please contact Dhara Satija at dharasatija@paulhastings.com and/or our HFMA Admin team at admin@ma-ri-hfma.org. We are always looking for volunteers so please reach out anytime of the year. We welcome your interest, feedback and support.
