WILEMS RESOURCE GROUP
HEALTH CARE Compliance & engagement Solutions
COMPLIANCE PROGRAM AUDITS & REVIEWS
COMPLIANCE PROCESS OVERSIGHT
We'll help the ACO implement and operationalize compliance.
PLAN REVIEW & GUIDANCE
We'll review and provide recommendations based on our experience with CMS/CMMI guidelines and regulations. We can help the ACO with:
- Marketing Plans & Materials
- Health Equity Plans
- Benefit Enhancement & Beneficiary Engagement Incentive Implementation Plans
BENEFICIARY & PROVIDER ENGAGEMENT
We'll help the ACO develop beneficiary and provider engagement initiatives.
OUR PRODUCTS
CLIENTS WE'VE HELPED
ACO COMPLIANCE OFFICER
Kimberly Busenbark will serve as the named Compliance Officer and the WRG team assists with the day-to-day compliance operations. The activities of the Compliance Team can be difficult to foresee, it may include but is not limited to:
- Documentation & Audit Preparedness for CMS Audits
- Investigation, Management, & Documentation of Compliance Issues and Privacy Concerns
- Marketing Material Submission and Reviews
- Website & Public Disclosure Oversight
- CMS Liaison Responsibilities
- Effective & Compliant Implementation of Operational Requirements including Training, Monitoring, Benefit Enhancements and Waivers
COMPLIANCE PROGRAM MANAGEMENT
We'll support the named ACO Compliance Officer with day-to-day operations and activities.
COMPLIANCE PROGRAM AND POLICY & PROCEDURE CREATION
We'll utilize existing elements to build a program and documentation that reflects the operational activities currently in place at the ACO.
ACO COMPLIANCE EDUCATION FOR LEADERSHIP
We'll develop and deliver a customized training to educate your ACO leadership on compliance program requirements, operational considerations, audit preparedness, best practices, and CMS red flag issues.
GENERAL COMPLIANCE RESOURCE
We'll be available if and when you need us to support the ACO Compliance Team.
our approach
COMPLIANCE TRAINING & REPORTING
COMPLIANCE PROGRAM READINESS REVIEW
We'll review documentation and determine if the ACO operations are sufficient to meet minimum regulatory requirements. Then, we help the ACO close identified gaps either through a hands-off (Corrective Action Review) or hands-on (Corrective Action Implementation) approach.
RESPOND TO CMS AUDITS
We'll help the ACO create and finalize a response to a CMS audit.
MOCK AUDITS
We'll conduct a mock audit that mimics a CMS audit of the required program elements. The following are examples of mock audits available: Compliance Program, Voluntary Alignment, Beneficiary Notification, Roster Management, Written Arrangements, and Benefit Enhancements.
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The Wilems Resource Group web-based platform allows individuals to complete compliance training or make a compliance report anytime from anywhere. Modules can be purchased separately based on your organization's needs. Upon completion of a training module, the individual submits a brief attestation to confirm their understanding of the material. Completion reports are generated and shared monthly with ACO leadership.
- REACH ACO Compliance Training Modules
- ACO Comprehensive Training (includes Overview, FWA, and Privacy in one module)
- ACO Consumer Advocate Training
- Shared Savings Program ACO Compliance Training Modules
- ACO Comprehensive Training (includes Overview, FWA, and Privacy in one module)
- ACO Data Custodian Training
- ACO Comprehensive Training (includes Overview, FWA, and Privacy in one module)
- Anonymous Compliance Reporting Tool – Individuals can report any compliance concerns regarding the organization or activities. The tool allows individuals to report anonymously or to provide contact information. Reports are then transmitted to the appropriate leaders within the ACO.
Compliance Program CONSULTING
Your organization has committed to providing high-quality, coordinated health care through participation in a Commercial, Medicare Shared Savings Program, or REACH ACO. Our main goal at Wilems Resource Group is to remove burdens and challenges your organization may face related to compliance requirements and engagement programs. We understand that your team needs to focus on the most important aspect of health care...the beneficiary.
At Wilems Resource Group, we measure success on our ability to help you understand program and model requirements, determine the appropriate level of acceptable compliance risk, and create programming that meets all regulatory requirements. Wilems Resource Group has helped organizations all across the country remain compliant and be successful within Medicare value-based care models and programs. We take the time to understand your company culture and business goals. We listen and learn from you. Working alongside your team, we then build customized compliance and engagement programs for your organization, physicians, practice managers, and beneficiaries.