Chapter 5 explored the extensive and detailed world of compliance and credentialing. We defined compliance and discussed its importance. We listed the components of an effective compliance program. We explained the value of having a compliance officer. We discussed major compliance topics. We addressed the need for human resources and a business policy and procedure manual. We explained credentialing and its role in your business. We then discussed risk management and the components of an effective risk management program. We discuss aspects of public safety and your business role in public safety. Finally, we explored the role of outsourcing in your business. The following exercises will help reinforce the concepts presented in the textbook.
Key Terms
Human Resources
The department of an organization that scouts for potential hires for an organization. A department within a business that deals with the hiring, administration, and training of personnel.
Credentialing
The process of verifying the licenses, certifications,
education, and professional backgrounds of professionals and facilities for hiring, insurance reimbursement, or other third party benefit.
Risk Management
Assessing workplace risks and works to find resolutions through policies and procedures.
Quality Assurance
The monitoring of a certain level of quality to a product or service providing by an organization
Quality Improvement
The proactive process of seeking out potential
problems in a organization and finding solutions before an issue arises.
Compliance
Business compliance is the means by which a business facility or organization maintains compliance with various government agencies,
governing business organization guidelines, and federal, state, and local
laws.
Certificates of Coverage
Documents from business insurance carriers that state any claims made on behalf of the insured.
Continuous Quality Improvement
A business management
methodology used to increase safety, efficiency, lower liability, improve operational flow, reduce operational cost, and improve employee and customer satisfaction. Its main tenant is that it is a continuous active proactive process.
Primary Source Verification
The process of obtaining proof of credentials form the original issuer of those credentials.
Recredentialing
The process of verifying that no events occurred during the period from the previous credentialing to the renewal date, and that all licenses and certifications are current and without any new incident.
Revenue Cycle
The cycle of submitted a bill or claim to a customer or insurance and receiving reimbursement.
Corporate Bylaws
A detailed set of rules adopted by a corporation’s board of directors after the company has been incorporated. They are an important legal document for a corporation to have in place as they specify its internal management structure and how it will be run.
Board of Directors
a team of people elected by a corporation’s shareholders to represent the shareholders’ interests and ensure that the company’s management acts on their behalf. The head of the board of directors is the chairman of the board.
Communications Record Keeping
The process of logging contact information of agency, organization, business, or other contact related to the development and establishment of your business.
ICANN
The Internet Corporation for Assigned Names and Numbers is a nonprofit organization responsible for coordinating the maintenance and procedures of several databases related to the namespaces and numerical spaces of the Internet, ensuring the network’s stable and secure operation.
DNS
The Domain Name System associates various information with domain names assigned to each of the participating entities. Most prominently, it translates more readily memorized domain names to the numerical IP addresses needed for locating and identifying computer services and devices with the underlying network protocols.
Expected Outcomes
Understand compliance and be able to describe its importance
Recognize the components of an effective compliance program
Understand the value of having a compliance officer
Understand major compliance topics
Recognize the need for human resources and a business policy and procedure manual
Understand credentialing and its role in your business
Understand risk management and the components of an effective risk management program
Recognize aspects of public safety
Be aware of the role of outsourcing in compliance and credentialing
Key Concepts
Business compliance is the means by which a facility or organization maintains compliance with various government agencies, governing organization guidelines, and federal, state, and local laws.
The core elements for an effective compliance program.
A compliance officer can manage the enormity of the tasks of business compliance, freeing you and other management staff to providing customer service.
In a small business, a compliance officer can manage multiple roles.
All employees should be given an orientation to ensure they are in compliance with the companyʼs business services.
You need to establish policies and procedures for your business.
Credentialing is part of compliance.
A compliance risk assessment is used to identify risk to the business and its customers and employees by analyzing the inherent risks in a particular area of care, service and the quality of controls implemented by the business to manage and mitigate those risks.
Risk management is not the elimination of risk, but rather the responsibility for risk that exists.
Continuous quality improvement is a more proactive means of managing risk than quality assurance.
OSHA, FEMA, and the HHS manage and protect workers and the public.
Using a third party to outsource credentialing can reduce cost and free staff to focus on other job duties.
Chapter Slogans
Cover your ass!
Consult your business attorney!
Get a compliance officer.
POUND THE PAVEMENT
Go to your local OSHA office, or meet with a compliance officer from another business. Ask if you can trail them for a day to get a better sense of how compliance fits into the everyday events of an organization.
THINGS TO CONSIDER
These answers are personal responses for you to consider. There are no correct answers to these questions.
