Compliance Officers have a myriad of risks to address. At Provident, we believe the following challenges should be prioritized for 2017 and included in healthcare Compliance Officer’s Compliance Work Plan:

• Quality Payment Program and other alternative payment models – With the rollout of MACRA, alternative payment models and bundles, compliance officers must work with operational staff and legal to ensure tools and processes are in place to capture and report required quality data elements to maximize quality, compliance and reimbursement.
• Privacy and Security – With the increasing audit and enforcement focus on privacy and security, compliance officers must work closely with privacy and security leadership to prioritize risk through a comprehensive risk assessment, identify gaps in privacy and security infrastructure (e.g., training, policy and procedures) and obtain confirmation that the proper security measures are in place and tested regularly.
• Key Areas of Risk – Government audit efforts remain fruitful requiring compliance officers to understand their organizational risk (e.g. 2016 Stark changes, DRG validation, new ICD-10 codes, patient status); develop an audit plan to address those risks; and, create mitigation strategies to reduce or eliminate the risk.
• Engaging the C-Suite – Providing annual compliance education is not enough anymore – compliance officers must educate and keep the c-suite engaged and knowledgeable of compliance risks through regular reporting, dashboards, decision-making, etc. to meet the heightened government standard.