Healthcare Regulatory Compliance 

Healthcare reform and a dynamic regulatory landscape are reshaping the healthcare industry. Resilience will be important for organizations to thrive, and the key to that resilience is the need for healthcare leaders to strengthen their approach to measuring, managing and mitigating risk, and responding properly to critical regulatory pressure points.

KPMG’s Healthcare Regulatory Compliance Advisory Practice offers a broad range of services designed to help healthcare organizations turn disruptive industry forces into sustainable advantage.

 

We are positioned to deliver thoroughly on all the major healthcare transformational themes, including:

 

  • ICD-10 Conversion
  • Revenue Transformation
  • Accountable Care Capabilities Development
  • Meaningful Use Achievement
  • Data Protection Processes, including compliance and other concerns emerging from the Health Insurance Portability and Accountability Act (HIPAA)

 

KPMG Healthcare can help you achieve sustainable performance improvements to meet your compliance challenges in this complex and transformational regulatory environment. Organizations can manage costs by strengthening risk management, increasing performance of management and services, leveraging reform initiatives, and enhancing revenue streams, which can lead to enhanced ROI through reduced costs and improved income.

 

Potential Benefits

Clients that have used KPMG have reported the numerous benefits, including:

 

  • Identification of potential risk points regarding HIPAA/HITECH compliance
  • Assistance with innovation as client develops segment strategies, centers of excellence, alternative payment or delivery models, and works to optimize for reform
  • Improved outcomes performance through the creation of next-generation gain-sharing and accountable care models, while addressing sub-optimal system service and demand characteristics that might otherwise diminish capacity for patient care
  • Help with behavioral and cultural change required to make the organization's initiatives sustainable
  • Improved cost management by increasing the performance of administrative management and services, improving clinical workflows, leveraging reform initiatives, and enhancing revenue streams and clinical cost models
  • Bringing sophisticated enterprise-wide program management skills to the table to increase the opportunity for complex initiatives to result in a practical “we got it right” conclusion
  • Bringing sophisticated enterprise-wide program management skills to the table to increase the opportunity for complex initiatives to result in a practical “we got it right” conclusion
  • Assistance with quality assurance, independent verification and validation, and testing strategies regarding transformational program initiatives

 

How KPMG Can Help

KPMG is currently working with healthcare organizations to:

 

  • Provide system implementation optimization and general revenue cycle program management evolving from ICD-10 program design assessment and roadmap development
  • Develop recommendations for compliance against MU requirements, current MU planning efforts, and dependencies with major compliance efforts (HIPAA 5010, ICD-10)
  • Design and implement a system-wide clinical documentation integrity program
  • Review a large regional health plan’s accountable care capabilities.
  • Transition an academic medical center faculty practice plan in its emergence as a risk-bearing organization
  • Transform care management processes in a nationally-scaled provider organization

    • For more information, please contact:

    Ed Giniat
    National Sector Leader — Healthcare & Life Sciences
    Chicago, IL
    312-665-2073
    eginiat@kpmg.com

Questions to consider:

  • Are you a significant user of (or are you implementing) certified electronic health records technology as mandated by the HITECH Act?
  • Is your organization prepared to sustain its privacy and security policies through formal federal audit under HIPAA?
  • Has your organization performed any payment modeling to gauge the impact of the transition from fee-for-service to value-based payment?
  • How satisfied are you with the performance and ROI of your overall compliance program?
  • Where is your organization relative to clinical integration concerns and strategies?
  • What is your organization’s status relative to ICD-10 transition?
  • Where is your organization relative to clinical integration concerns and strategies?
  • Is your organization considering how to better measure, report and govern quality metrics?
  • Is your organization pursing accountable care strategies
  • Is your organization struggling to manage multiple complex projects on an enterprise-wide basis?