SAI Global Compliance announced Monday the findings of its 2012 Health Insurance Compliance Benchmark Study and 2012 Healthcare Compliance Benchmark Study.
As the Centers for Medicare and Medicaid Services (CMS) continues to increase its emphasis on proactive compliance, both healthcare providers and insurers cited “demonstrating compliance effectiveness” among their top compliance program priorities for 2012.
[See also: Compliance efforts to increase in 2012]
SAI Global Compliance, a leading provider of governance, risk and compliance (GRC) products, services and technology, found that 75 percent of the survey participants from the provider organizations noted compliance self-assessments and demonstrating compliance effectiveness as their highest priority. This indicates a sharp increase in prioritization, up from only 40 percent in the survey just two years ago.
Similarly, participants from payer organizations noted compliance self-assessments and demonstrating compliance effectiveness among their top three priorities. Additionally, 82 percent of the payers cited increasing proactive focus and audits from CMS as the main driver of their compliance priorities.
“Most healthcare providers and insurers are increasing their budgets and putting more money into their compliance effectiveness,” said Steve McGraw, GRC president at SAI Global Compliance. “Organizations are also looking at their priorities and being more proactive by outlining criteria that they can use to measure the effectiveness of their programs.”
In July 2011, CMS issued a compliance program self-assessment questionnaire for payers, largely based on the Seven Elements of an Effective Compliance and Ethics Program, as outlined in the U.S. Sentencing Guidelines. Many healthcare organizations viewed this as signaling a shift from retrospective audits to more proactive measures and began to focus on demonstrating compliance effectiveness as a higher priority.
“Healthcare reform is shining a brighter light on compliance, so we were not surprised to see healthcare providers and payers placing higher priorities on demonstrating their compliance program effectiveness this year,” said McGraw. “As budgets continue to be stretched and regulatory scrutiny increases, healthcare organizations must be confident that their compliance programs can withstand intense examination. Generally, CMS wants payers and providers to show that as an organization they are demonstrating compliance – that they have a living, breathing program that displays this.”
SAI Global Compliance provides organizations with a wide range of GRC products, solutions and services that help build organizational integrity and meet overall business objectives.
To download copies of the free surveys or learn more about the seven elements of effective compliance programs, visit the Healthcare Resource Center at http://www.compliance360.com/healthcare, or the Health Insurance Resource Center at http://www.compliance360.com/insurance.
[See also: Compliance: Expert insights]
[See also: Payer News Briefs]