Regulatory compliance risk assessment and management is critical to the success of a health care compliance program. Risk assessment and management is a continuous process to sustain long-term compliance with health care laws, rules and regulations. Strategic Management developed a regulatory compliance risk management process that is carried out in four phases: Assessment, Remediation, Monitoring and Auditing and Risk Reporting.
Compliance Risk Assessments (CRAs) are important in addressing a variety of business risks in the healthcare sector and are used to identify, prioritize, and control risks associated with the threat of non-compliance with legal, regulatory, and other compliance standards. Potential penalties could be fines, reputation damage, legal repercussions, or the inability to operate the business. CRAs can identify any deficiencies, inefficiencies, and risk exposure; and enhance compliance program effectiveness. There are several different types of risk assessments, but the compliance risk is a specific one focusing on the compliance of the business with applicable laws, which can protect a business from reputational exposures and fines.
Risk assessment enables organizations to identify weaknesses in its internal controls and systems and mitigate high-risk areas. Strategic Management’s approach to risk assessment is to first identify compliance risks through an in-depth review of regulatory requirements, such as referral sources, HIPAA privacy and security, claims development and submission. This phase concludes with an impact and probability analysis that prioritizes risks and prepares for the remediation phase.
The high-risk areas remediation phase includes ranking risks, developing a work plan to remediate those risks and implementing policies, procedures and controls to address those risks. A key component of this phase is educating the Compliance Department so that they can identify risk, understand what causes risk and how to manage and mitigate risk.
Risk Monitoring and Auditing
The risk monitoring and auditing phase is an on-going phase of risk assessment. Strategic Management assists health care organizations to design and implement controls to monitor policies, procedures and systems. We also perform independent and objective audits to determine whether effective policies, procedures and systems are in place to assess risks.
Risk reporting is the final phase of risk assessment. Strategic Management prepares a formal report to advise the Board of Directors and executive management of the high-risk areas identified during the risk assessment and how such risk will be mitigated through the remediation, monitoring and auditing phases.